Terms and Conditions
Version 1.0
Last Updated: 27.08.2026
IMPORTANT – NATURE OF SERVICES (“Notice”)
[beginning of the Notice]
THE SERVICES PROVIDED BY PFM THROUGH ITS AUTHORIZED REPRESENTATIVE/S OR EMPLOYEE/S ARE OFFERED FOR COACHING AND GENERAL WELL-BEING PURPOSES ONLY, AS MORE SPECIFICALLY DESCRIBED IN THESE TERMS AND CONDITIONS.
NEITHER PFM NOR ANY OF ITS REPRESENTATIVES OR EMPLOYEES ARE LICENSED HEALTHCARE PROVIDERS, PSYCHOLOGISTS, PSYCHOTHERAPISTS, SOCIAL WORKERS, MEDICAL PROFESSIONALS, OR LEGAL PROFESSIONALS UNDER THE GOVERNING LAW INDICATED IN CLAUSE 13 OF THESE TERMS AND CONDITIONS. THE SERVICES PROVIDED DO NOT CONSTITUTE MEDICAL, PSYCHOLOGICAL, PSYCHIATRIC, THERAPEUTIC, LEGAL, OR CLINICAL ADVICE, ASSESSMENT, DIAGNOSIS, OR TREATMENT OR ANY OTHER ADVICE.
PARTICIPATION IS VOLUNTARY, AND CLIENTS REMAIN FULLY RESPONSIBLE FOR THEIR OWN DECISIONS, ACTIONS, AND OUTCOMES. THE SERVICES ARE NOT A SUBSTITUTE FOR PROFESSIONAL HEALTHCARE, MENTAL HEALTH TREATMENT, MEDICAL CARE, OR LEGAL ADVICE. IF YOU OR YOUR RELATIVES, INCLUDING CHILDREN, ARE EXPERIENCING MENTAL HEALTH CONCERNS, MEDICAL ISSUES, ABUSE, OR SITUATIONS REQUIRING URGENT OR SPECIALIST ASSISTANCE, YOU SHOULD SEEK SUPPORT FROM A QUALIFIED AND LICENSED PROFESSIONAL OR APPROPRIATE AUTHORITY.
BY ENGAGING WITH PFM’S SERVICES AND ACCEPTING THE BELOW TERMS AND CONDITIONS, CLIENTS ACKNOWLEDGE AND AGREE TO THE NATURE AND LIMITATIONS OF THE SERVICES PROVIDED.
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1. DEFINITIONS
In these Terms and Conditions:
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“PFM”, “we”, “us”, or “our” refers to PRESERVE FUTURE MANAGEMENT LIMITED, a company incorporated and registered in the Republic of Cyprus, with Reg. No HE 474565 and registered office at Kinyra, 1, Kinyras Tower, 3rd floor, Flat/Office 301, Agios Andreas, 1102, Nicosia, Cyprus. Our contact details are:
Company Name: PRESERVE FUTURE MANAGEMENT LIMITED
Business Address: 8 Karaiskaki street, 3rd floor, office 3.08, CY-3032, Limassol, Cyprus
Email: support@pfm.company
Telephone Number: +357 25 056416
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“Services” means the coaching, practical support, and access to resources, and the other services as particularly described in Clause 3 of these Terms and Conditions, provided by PFM through its authorized representative(s) and/or employee(s), including one-on-one or group coaching services, whether provided in-person, online, or through any other medium. “Service” shall be construed accordingly. “Agreed Service(s)” shall mean the specific Service(s) agreed between the Client and PFM pursuant to these Terms and Conditions, in accordance with the process described in Clause 5 herein.
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“Client” or “you” means the individual who books and/or receives the Services.
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“Party” or “Parties” means the Client and PFM individually or collectively.
2. AGREEMENT TO TERMS AND CONDITIONS
These Terms and Conditions (“T&Cs or Terms and Conditions”) govern your engagement with us and use of any Services provided to you by PFM as described herein. By booking, registering for, or otherwise confirming an Agreed Service in accordance with the booking process described herein, you confirm that you have read, understood, and agree to be bound by these T&Cs, as in effect at the time of booking, including the Notice above regarding the nature of the Services provided by PFM. Please read these T&Cs carefully before booking or registering for any of our Services.
If anything in these T&Cs is unclear, please contact us at: support@pfm.company before booking or participating in any Services.
3. NATURE AND SCOPE OF SERVICES PROVIDED
PFM provides coaching, educational guidance, practical support, wellbeing-related resources, and other informational materials designed to assist individuals, including parents, in personal development, wellbeing, body-awareness and self-awareness, self-care, self-actual engineering, lifestyle practices, resilience, and the management of everyday challenges and stress in an integrative manner and following the holistic approach to your body, energy and mind.
The Services may include, but are not limited to:
• Integrative and holistic approaches incorporating coaching, mindfulness, awareness of physical sensations, relaxation, self-care, self-actual engineering, healthy lifestyle practices, movement-based practices, and personal development;
• Guided body-awareness, movement, and relaxation practices intended to promote awareness of physical sensations, ease, comfort, and overall wellbeing;
• Mindfulness, relaxation techniques, awareness of physical sensations, movement-based practices, and other wellbeing practices intended to support relaxation, resilience, comfort, and general wellbeing;
• Individual or group coaching sessions relating to personal development, wellbeing, body-awareness and self-awareness, lifestyle practices, parenting, and everyday challenges;
• Educational guidance, by providing of information, ideas, and resources relating to wellbeing, self-care, self-actual engineering, mindfulness, resilience, lifestyle balance, and personal development;
• Discussions and guidance relating to lifestyle habits, daily routines, self-care and self-improvement practices, wellbeing planning, and the management of everyday stress;
• Worksheets, exercises, frameworks, and other tools intended to support personal development, wellbeing-related goals, and the adoption of healthy lifestyle practices;
• Access to general educational, informational, and wellbeing-related materials;
4. DELIVERY OF SERVICES
The Services and any Agreed Services shall be delivered by PFM’s designated employee(s) with relevant skills, training, and experience appropriate to the Services, and will be provided in the manner agreed at the time of booking, whether in person, online, or by such other means as may be agreed by the Parties.
5. BOOKING AND PAYMENT PROCESS
5.1 Services and Pricing
PFM offers the Services as described in Section 3 of these Terms and Conditions. The specific Services to be provided, together with the associated costs (including any applicable taxes), are discussed with the Client through direct written communication with PFM or its authorized employee (including but not limited to messaging platforms such as WhatsApp or Telegram, or other mutually agreed methods between the Client and PFM) prior to the Client’s submission of a booking.
Following such communication, the Client may indicate the Services and pricing they wish to proceed with and express their intention to proceed with a booking at a specific date and time for the provision of the Services by PFM.
The Client agrees to receive an electronic invoice or electronic receipt from PFM within a reasonable time after the delivery of the Agreed Services, in accordance with applicable law.
5.2 Submission of bookings
5.2.1 Initial booking of Services by new Clients
Following the initial communication between the Client and PFM, as described in clause 5.1, the Client will be provided with a booking method (the “Booking Method”), which may include a website-based form, or a Google Form, to enable the Client to proceed with a booking of Services. Specific date and time for the provision of the Services should be agreed directly by the Client with PFM or its authorized employee before the Services are provided, and such date and time shall form a part of Agreed Services. The Booking Method contains the applicable Terms and Conditions and Privacy Notice for the Client’s review.
By completing and submitting the Booking Method, the Client confirms that they have read and understood PFM’s Terms and Conditions and Privacy Notice, agrees to be bound by the Terms and Conditions, and acknowledges and understands how their personal data will be processed by PFM in the context of the Client’s booking and receiving the Agreed Services. The Client further confirms acceptance of the relevant Services and pricing as previously discussed with and communicated to the Client by PFM.
The contract for the provision of the Agreed Services under these Terms and Conditions is concluded upon submission of the completed Booking Method.
5.2.2 Subsequent bookings of Services by existing Clients
Subsequent bookings may be made either:
(a) by confirming the Agreed Services, date and time for their provision, and price with PFM via direct written communication between the Client and an authorized representative or employee of PFM (including, but not limited to, WhatsApp or Telegram), followed by completion and submission of the Booking Method made available by PFM or on its behalf. In such cases, the contract for the provision of the Agreed Services is concluded upon submission of the completed Booking Method. Where the Client submits a completed Booking Method without having agreed a specific date and time with PFM, the Client shall contact PFM or its authorised employee to agree on the date and time for the provision of Services; or
(b) by communicating directly with an authorized representative of PFM to arrange the relevant appointment and confirm the Agreed Services and price via a method of direct written communication, including but not limited to WhatsApp or Telegram. Where the booking is arranged directly with a representative of PFM, the contract is concluded when the Client confirms the Agreed Services and price in writing (which, for the avoidance of doubt, includes confirmation by direct written communication, including but not limited to WhatsApp or Telegram).
Each subsequent booking constitutes a separate contract for the provision of the Agreed Services and is governed by the version of these Terms and Conditions, and Privacy Notice in force at the time of that booking. The applicable Terms and Conditions and Privacy Notice are available for review at the following link: https://www.pfm-serv.com/ or at https://drive.google.com/drive/folders/1V6guClGZhZmbQZMqwjaGkvfORKjvQJni?usp=sharing are provided to the Client prior to the conclusion of each contract.
Important:
Please carefully read these Terms and Conditions and the Privacy Notice before proceeding with any booking of the Services.
5.3 Payment method and Delivery of Agreed Services
5.3.1 Payment for the Agreed Services shall be made via Revolut or any other payment method made available by PFM from time to time, including, where applicable, payment links, QR codes, Revtag, or other payment functionality integrated within the Booking Method. Payment shall be due at the time of submission of the Booking Method or at such other time as PFM may specify in writing at the time of booking.
5.3.2 Subject to these Terms and Conditions, the Agreed Services will be delivered as agreed, following receipt of payment as outlined in Clause 5.3.1. PFM reserves the right not to commence or to suspend provision of the Services where payment has not been received when due and/or, in such circumstances, to cancel the booking, in which case PFM shall have no obligation to provide the Agreed Services.
5.3.3 Where the Client fails to attend a scheduled Service at the agreed time (including where the Client is more than a reasonable grace period late or is otherwise unavailable), the Agreed Service shall be deemed to have been made available, and PFM shall not be obliged to refund the Client or reschedule the Service, except at sole discretion of the PFM. This Clause 5.3.3 shall not limit any right of withdrawal available to the Client under Clause 6.1.
5.4. Acknowledgement
By engaging with PFM as set out in Clause 5.1-5.3 (including, where applicable, the submission of the Booking Method), you acknowledge the following:
(a) The Agreed Services are intended to be delivered in accordance with these Terms and Conditions and the agreed scope, description, and price, as communicated and agreed in accordance with Clauses 5.1-5.3.
(b) You retain the right to dispute the Agreed Services if they do not meet the agreed terms or as otherwise required by applicable consumer protection laws;
(c) Where the Agreed Services have been delivered in accordance with these Terms and Conditions, no claim or refund shall arise solely on the basis of dissatisfaction or personal preference regarding the Agreed Service or its outcomes, to the extent that this does not affect your statutory right of withdrawal or other mandatory consumer rights.
Nothing in this clause 5.4 shall limit or exclude your statutory rights under applicable law, including the right to request a refund or cancellation where such rights cannot be lawfully excluded by law.
6. CANCELLATIONS AND REFUNDS
6.1 Right of Withdrawal
The Client has the right to withdraw from the contract within fourteen (14) days from the date the contract is formed under these T&Cs, unless an exception applies under applicable law.
If the Client has expressly requested that the Agreed Services begin during the withdrawal period, the Client shall be liable for payment of a proportionate amount for the Agreed Services provided up to the date of withdrawal. The proportionate amount will be calculated based on the total price of the Agreed Services and the portion of services actually provided up to the date of withdrawal. Any amounts paid in respect of services not yet provided will be refunded. Refunds will be processed within five (5) working days and, in any event, no later than fourteen (14) calendar days from receipt of the withdrawal notice.
If the Agreed Services have been fully performed within the withdrawal period, the right of withdrawal is lost where the Client has expressly requested the Agreed Services to begin during the withdrawal period and has acknowledged that the right of withdrawal will be lost upon full performance.
To exercise the right of withdrawal, the Client must notify PFM by a clear unequivocal written statement sent to support@pfm.company. Alternatively, the Client may also use the model withdrawal form provided in Annex I of these T&Cs, although this is not obligatory.
If you have any questions regarding the right of withdrawal, including whether any exception applies, please contact us at the contact details provided above and we will be happy to assist you.
6.2 Cancellation after the Withdrawal Period
After expiry of the statutory withdrawal period, the Client may request cancellation of the Agreed Services at any time by providing written notice to PFM at the following email address support@pfm.company. Cancellation takes effect from the date the notice is received and applies only to Services not yet provided.
6.3 Non-Refundable Services
Except as required by applicable mandatory consumer protection laws and without prejudice to the Client’s statutory right of withdrawal, fees for Agreed Services that have already been provided prior to the effective date of cancellation are non-refundable, including where the Client does not make use of all Agreed Services made available before cancellation.
6.4 PFM-Initiated Cancellations
If PFM is unable to provide the Agreed Services for a material part of a booking due to circumstances within PFM’s reasonable control, PFM shall notify the Client and a proportionate adjustment or refund will be applied in respect of the affected services.
6.5 Statutory Rights
Nothing in this section shall limit or exclude any mandatory rights the Client may have under applicable consumer protection laws.
7. CLIENT ACKNOWLEDGEMENT AND RESPONSIBILITIES
By participating in PFM’s Services, whether provided in person or online, you acknowledge and agree to the following:
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Eligibility and Accuracy of Information:
You confirm that you are at least 18 years of age, and that the information provided to us in connection with booking and receiving the relevant Service/s is true and accurate.
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No Guarantee of Results
The Services are intended to support personal reflection, skill-building, and general well-being. However, individual experiences of clients and outcomes may vary. You acknowledge that outcomes depend on your level of engagement and how you choose to apply any insights from the Services, as well as on numerous factors, including your personal circumstances and external conditions. PFM does not guarantee or warrant any specific results, improvements, or changes as a consequence of the Services. The Client remains solely responsible for their own decisions, actions, and outcomes arising from or in connection with the Services.
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Client Responsibility for Childcare and Supervision
Although the Services include coaching in parenting care, they do not constitute or include childcare, supervision, or oversight of minors in any form. PFM does not assume responsibility for the safety, behaviour, or whereabouts of any child at any time. The Client remains fully and solely responsible for supervising and ensuring the well-being of their child at all times.
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Voluntary Provision of Information
Certain information may be necessary for the arrangement and provision of the Agreed Services. Any additional personal information you choose to share about yourself, any relevant health conditions, limitations, allergies or your personal circumstances is provided voluntarily and is intended solely to help tailor the Agreed Service/s to your needs. You are not obliged to disclose any personal information beyond what is necessary for the provision of the Agreed Services.
PFM shall not be liable for any adverse consequences arising from the Client’s failure to disclose relevant information fully and accurately, where such information is necessary for the proper provision of the Agreed Services.
Please refrain from sharing information that is unnecessary or irrelevant to the purpose of the Agreed Service/s. Where information relating to children is shared, you confirm that you are the child’s parent or legal guardian or otherwise have the lawful authority to provide such information, and that only information which is appropriate and necessary for the purposes of the Agreed Service/s is disclosed.
All personal data provided will be handled in accordance with applicable data protection legislation and our Privacy Notice.
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Nature of the Services
You acknowledge that you have read and understand the nature and scope of the Services provided by PFM as described in these T&Cs.
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Professional Advice
You acknowledge and agree that PFM’s Services do not constitute medical, mental health, therapeutic, or legal advice or other similar regulated activities. You are solely responsible for seeking independent professional guidance for any such matters affecting you or your child.
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Confidentiality and Respect
When participating in any session, you agree to:
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respect the privacy of all other participants,
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keep any personal or sensitive information shared by other participants during the session strictly confidential, and
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use such information only for the purpose of participating in the session.
Clients are advised to share only information they are comfortable disclosing in group sessions. You acknowledge that PFM cannot control or guarantee the actions of other participants or any disclosure of information by them and you participate in group sessions with this understanding.
Any breach of the confidentiality obligations hereunder by a Client shall constitute a material breach of these T&Cs and will be treated in accordance with clause 11, with no refund of any amounts already paid by the Client. of these T&C’s.
All materials and information provided by PFM to the Client are confidential and may not be shared with any third party unless disclosure is required by applicable law or authorised by PFM in writing.
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Client responsibility for attendance
Where a Service or Services you have booked require/s your physical attendance, it is your responsibility to:
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Verify the location of any sessions, workshops, or similar events relevant to that Service; and
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Allow sufficient time to travel to the venue before the relevant activity begins.
Where an Agreed Service is provided via video conferencing or other online methods (e.g. Zoom, Google Meet, Telegram, WhatsApp), it is your responsibility to:
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Ensure you have the necessary equipment and facilities to access the Agreed Service (such as a personal computer, stable internet connection, and required software); and
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Make yourself available and ready to participate at the scheduled time.
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Access the session in a private and secure environment and use devices and networks that are adequately protected to ensure your personal data is kept confidential.
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Personal Responsibility
You understand that any decisions or actions you take following the receipt of any Services are entirely your own responsibility, and PFM is not liable for any outcomes resulting from the Client’s own decisions or actions.
8. LIMITATION OF LIABILITY
8.1 Nothing in these T&Cs shall exclude or limit our liability where it would be unlawful to do so under applicable Cyprus or other mandatory law, including liability caused by our own action/s or omission/s.
8.2 PFM is the contracting party for the provision of all Services. Any acts or omissions of PFM’s employees, officers, or other representatives in connection with the Services are treated as acts or omissions of PFM. Nothing in this clause affects your statutory rights as a consumer to bring claims where such rights cannot be limited or waived by law.
8.3 Subject always to clause 8.1, our total aggregate liability to you for all claims arising under or in connection with these T&Cs shall not exceed the total fees paid by you for Agreed Services during the 12 months immediately preceding the event giving rise to the claim. This limitation does not affect any liability which cannot be limited or excluded by law.
8.4. Subject to clause 8.1, we shall not be liable for any losses that were not reasonably foreseeable at the time the Agreed Services were provided, including any indirect or consequential losses, loss of profit, loss of opportunity, loss of anticipated benefit, or losses arising from decisions made or actions taken by you based on the Agreed Services, misuse of the Services, or circumstances outside our reasonable control.
8.5 Our Services do not constitute medical, psychological, therapeutic, clinical, legal advice or any similar regulated activity. They should not be relied upon as a substitute for consultation with a suitably qualified professional. You are solely responsible for your own decisions, actions, and outcomes. For any medical, mental health, or legal matters, you agree to consult an appropriately qualified professional.
9. DATA PROTECTION
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Any personal information you provide for the purpose of accessing or using our Services will be treated confidentially and in accordance with applicable data protection legislation.
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For full details on how we handle your personal data, please see our Privacy Notice
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In group sessions, all participants are expected to respect each other’s privacy and keep all shared information confidential.
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By participating in group sessions, you acknowledge that you share information at your own discretion, and you agree not to disclose personal information shared by other participants.
10. INTELLECTUAL PROPERTY
All materials, resources, and content provided through the provision of the Services including any documents and presentations (the “Materials”) remain the exclusive property of PFM and/or its licensors, unless otherwise expressly stated in writing.
The Materials are provided to the Client for personal, non-commercial use only. Subject to the Client’s ongoing compliance with these Terms and Conditions, PFM grants the Client a limited, non-exclusive, non-transferable, revocable license to access and use the Materials solely for the Client’s own educational and personal development purposes. Any use outside the scope of this license is strictly prohibited, and all rights not expressly granted are reserved by PFM.
Except as provided herein, the Client may not copy, reproduce, distribute, share, sell, sublicense, publish, display, modify, create derivative works from, or otherwise exploit the Materials, in whole or in part, without the prior written consent of PFM.
Unauthorized use of the Materials constitutes a material breach of these T&Cs and may result in immediate termination of the Services and PFM’s pursuit of any remedies available under applicable law, including injunctive relief, to protect its intellectual property rights.
The Client acknowledges that continued possession of the Materials following termination or unauthorized use may infringe PFM’s intellectual property rights and agrees, upon request, to delete or destroy the Materials in their possession or control, except where retention is required by law.
11. TERMINATION
Subject to any restrictions in applicable law, PFM may suspend or terminate the provision of the Agreed Services where the Client is in material breach of these T&Cs, where continuation of the Agreed Services would be, in the reasonable opinion of PFM unsafe or inappropriate, or in the event of Force Majeure, as stipulated and in accordance with clause 12 below. The Client may request termination of future Services at any time. Any consequences of termination, including fees, refunds, or adjustments, shall be determined in accordance with Section 6 of these T&Cs and applicable law. Nothing in this clause affects the Client’s statutory right of withdrawal. PFM may also pursue any other remedies available under law or equity, including, without limitation, compensation for losses or damages suffered as a result of the Client’s breach of these T&Cs, injunctive relief to prevent further breach, or any other legal or equitable remedies available to it.
12. FORCE MAJEURE
Sometimes, events beyond our control may affect the delivery of our Services. These can include, for example:
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Severe weather, natural disasters, fire, flood, or other emergencies;
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Pandemics or public health emergencies;
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Strikes, labor disputes, or staff shortages;
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Power outages, internet, or technology failures;
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Government actions, civil unrest, war, terrorism, or similar events.
If such an event happens:
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We will let you know as soon as possible.
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We may need to postpone, reschedule, or change how the Services are delivered.
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We cannot be held responsible for losses or inconvenience caused by these events.
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If the situation lasts for a long time (e.g., more than 30 days), either you or we can end the affected Services. You will receive a refund for any Services you have paid for but we cannot provide.
For the avoidance of doubt, Clients are responsible for ensuring they have the necessary technology, internet access, and environment to participate in online sessions. Any technical issues caused by the client’s equipment, connectivity, or environment (“Client-side Technical Issues”) shall not constitute a Force Majeure Event. In respect of group online sessions, any session made available by PFM through the provision of necessary access links or instructions, and where the session platform is operational and proceeds as scheduled, will generally be considered delivered even if the Client fails to participate due to Client-Side Technical Issues, unless otherwise required by applicable law. In respect of individual online sessions, any rescheduling or alternative arrangement in the event of Client-side Technical Issues shall be at the sole discretion of PFM and shall not be treated as an obligation on the part of PFM.
Nothing in this section affects your statutory rights under applicable mandatory consumer protection laws.
13. GOVERNING LAW & JURISDICTION
These T&Cs shall be governed by and construed in accordance with the laws of the Republic of Cyprus, without prejudice to the protection afforded to you by the mandatory law applicable to you.
If a dispute arises in connection with the Services, we encourage you to contact us in the first instance so that we may seek to resolve the matter amicably. This does not affect your statutory rights.
You remain entitled to exercise all your statutory consumer rights under Cyprus, the EU or other applicable law, including the right to seek redress through the courts or an accredited alternative dispute‑resolution (ADR) body.
If amicable resolution is not possible, either Party may bring proceedings before the courts of the Republic of Cyprus, unless the mandatory law applicable to you requires proceedings to be brought before the courts of the country in which you are habitually resident.
14. SEVERABILITY
If any provision of these Terms and Conditions is found to be invalid, unlawful, or unenforceable by a court or other competent authority, such provision shall be deemed modified to the minimum extent necessary to make it valid and enforceable. If such modification is not possible, the provision shall be deemed severed from this Agreement. Any such finding shall not affect the validity and enforceability of the remaining provisions, which shall continue in full force and effect.
15. ENTIRE AGREEMENT
These Terms and Conditions, together with the Privacy Notice and any service and price confirmations communicated to the Client in accordance with Clause 5, constitute the entire agreement between the Parties and supersedes all prior discussions, communications, or understandings relating to its subject matter.
16. CHANGES TO THESE TERMS AND CONDITIONS
We may update these Terms and Conditions from time to time to reflect changes to our Services, legal or regulatory requirements, or our business practices.
Any updated Terms and Conditions will be published at https://www.pfm-serv.com/ and at: https://drive.google.com/drive/folders/1V6guClGZhZmbQZMqwjaGkvfORKjvQJni?usp=sharing, together with the date on which they take effect.
Updated Terms and Conditions will apply only to Services booked on or after the stated effective date and will not affect Services already booked, paid for, or provided before that date, except where required by applicable law or a regulatory authority.
By making a booking on or after the effective date, you confirm that you have reviewed and accepted the updated Terms and Conditions.
If you do not agree to the updated Terms and Conditions, you may choose not to make further bookings, without any additional charge or penalty.
Annex I – Model Withdrawal Form
(complete and return this form only if you wish to withdraw from the contract)
— To PFM
Address:
E-mail/Fax:
I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract for the provision of the following service (*): [TO INSERT HERE DETAILS OF SERVICE]
Ordered on (*)/received on (*):
Name of consumer(s):
Address of consumer(s):
Signature of consumer(s) (only if this form is notified on paper),
Date (*)