411Numbers HK Limited Removal Request Form ⎯ version 20151003

RemovalRequestFormTorequesttheremovalofyourrecordscompletetheformbelow.SignandmailthisformwithaphotocopyofoneofyourUtilityBill.

YourInformationLastName FirstName PhoneNumber

StreetAddress City State/Province

PostalCode Country EmailAddress

RecordInformationWebaddresses(URLs)whereyourrecordsareshown:

1. ____________________________________________________________

2. ____________________________________________________________

3. ____________________________________________________________

4. ____________________________________________________________

5. ____________________________________________________________

YourSignature DateSigned

411Numbers HK Limited Removal Request Form ⎯ version 20151003

NOTICE

1. Incompleteformswillnotbeprocessed.

2. RequestsmailedwithoutaclearUtilityBill’scopywillnot

beprocessed.

3. WeneedtoseeyournameandaddressontheUtilityBill.Iftheaddressdoesnotmatchtherecordwehaveforyou

online,explainthereasononadifferentpageandadditto

yourrequest.

4. Onceweprocessyourrequestwewilldestroy(shred)this

formandthecopyofyourUtilityBill.

5. Allowupto4weeksforprocessing.

MailingAddress411NumbersLimited

Borsigstr.9

10115,Berlin

Germany