Complaint form

To be completed by a BackOffice Outsourcing Sp. z o.o. employee

Complaint reference number: ____________________

Date received by the Operator: ____________________

Subject/reason for the complaint: ____________________

Reasons to select: delayed delivery, loss, destruction, damage, non-delivery of a registered item. Item type: registered letter, parcel or courier item.

Proof of posting of the registered item (to be completed by the Operator): ____________________

Attach a copy/scan of the proof of posting for record-keeping and further proceedings.

Complainant's full name and address (street and number, postcode and city; registered office) or company address stamp: ____________________

Name of the person submitting the complaint: ____________________

Telephone number and email address: ____________________

Full delivery address of the item concerned (street and number, postcode and city): ____________________

Full description of the incident, including evidence of damage, destruction, loss or delivery of the registered item contrary to the regulations and general conditions of postal services: ____________________

Amount claimed in PLN, if compensation is requested under the regulations and general conditions of postal services: ____________________

Other documents and information: ____________________

The personal data above will be processed by BackOffice Outsourcing Sp. z o.o., Al. Stanów Zjednoczonych 72/12, 04-036 Warszawa, to handle this complaint. Customers have the right to access and correct their data. Providing data is voluntary but necessary to handle the complaint.

I agree to receive commercial information from BackOffice Outsourcing Sp. z o.o. by electronic means within the meaning of the Act of 18 July 2002 on the Provision of Services by Electronic Means (Journal of Laws No. 144, item 1204, as amended). ☐

Date and legible signature of the person submitting the complaint: ____________________

Date and legible signature of the BackOffice Outsourcing Sp. z o.o. employee: ____________________