Expediente

DETAILS OF THE SUPPLY CONTRACT HOLDER

First name*:

Surnames*:

Phone no.*:

E-mail*:

ID Card/Foreigner ID No.*:

Address*:

Town*:

Province*: Required

Contract number*:

Company in question*: Required

DETAILS OF THE REPRESENTATIVE OF THE SUPPLY CONTRACT HOLDER.

It is essential to attach authorization accrediting the representation and photocopy of the ID Card/Foreigner ID No. of the contract holder and representative

Same data as the supply.

First name*:

Surnames*:

Phone no.*:

E-mail for notifications*:

ID Card/Foreigner ID No.*:

Address for notifications*:

Town*:

Province*: Required

Contract number*:

Company in question*: Required

REASON FOR THE CLAIM AND DESCRIPTION OF THE INCIDENTS*

REQUEST(SPECIFY YOUR REQUEST DETERMINING, IF APPROPRIATE, AMOUNT, BASIS AND DOCUMENTATION)*

Text Verification Required

The submission of the claim to the Customer Counsel Office (OCC) implies that you authorize the aforementioned OCC to request, from the company to which the claim refers, the information strictly necessary to handle and resolve the claim. This form will likewise be provided to the company in question for the sole purpose of handling your request.

Basic personal data protection information:
Data controller	AGBAR, S.L.U
Purpose	Provision of the management service for the claim submitted on the form. Conducting of surveys related to the claim management service.
Legitimacy	Execution of the claim management service. The conducting of surveys on the service is considered to be a purpose compatible with the provision of the claim management service.
Addressees	To handle the claim your personal data must be communicated to the "Company in question" that you identified on the form. Data processors located within the European Union. AGBAR, S.L.U. hires data storage services from Microsoft Ireland, which subcontracts to Microsoft Corporation, located in the USA. Therefore, your data could be transferred to the USA, under the protection of the Privacy Shield and of the decision of the Spanish Data Protection Agency on the legality, under certain conditions, of the transfers made to this entity.
Rights of the individuals	You are entitled to access, rectify and delete your data, and to exercise other rights, as detailed in the additional information on personal data protection.
Additional information	You may obtain additional information on the processing of your personal data below.

I have read the basic information about data protection and I accept. Required

DETAILS OF THE SUPPLY CONTRACT HOLDER

First name*:

Surnames*:

ID Card/Foreigner ID No.*:

E-mail*:

Phone no.*:

Address*:

Town*:

Province*:

Contract number*:

Company in question*:

DETAILS OF THE REPRESENTATIVE OF THE SUPPLY CONTRACT HOLDER.

First name*:

Surnames*:

ID Card/Foreigner ID No.*:

E-mail*:

Phone no.*:

Address for notifications*:

Town*:

Province*:

Contract number*:

Company in question*:

REASON FOR THE CLAIM AND DESCRIPTION OF THE INCIDENTS*

REQUEST(SPECIFY YOUR REQUEST DETERMINING, IF APPROPRIATE, AMOUNT, BASIS AND DOCUMENTATION)*

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