Name and surname of person who orders at the VGP side:……………………………………………………………………………………………………………

PLEASE FILL IN USING CAPITAL LETTERSONLY OR ELECTRONICALLY

1.COMPANY

Full name of company and its legal form ......

Adress......

......

2.BANK

Name of the bank:......

Bank account number (IBAN):......

Account’s owner:......

3.UE VAT number

UE VAT number:......

Name of owner of the UE VAT number:......

4.CONTACT INFORMATION(contact person)

...... (name, surname, e-mail adress, phone number)

The data controller of the data provided in this form by supplier who is a natural person is: Volkswagen Group Polska sp. z o.o. with registered office in Poznan (61-037), ul. Krancowa 44, e-mail: (VGP). You can contact the Data Protection Officer at the e-mail address: or in writing to the address of the registered office. The data will be processed in order to register the supplier in the VGP purchasing system, which takes place in order to undertake and conduct cooperation between VGP and the supplier by the supplier's will, based on the legitimate interest of VGP. Providing data is voluntary but it is necessary to initiate the cooperation. In the case of applying forthe purchase order or conclusion of a contract, the data will be processed in order to conclude, carry out this contract and services provided as part of it, as well as to prove the conclusion of the contract on the basis of tax and accounting law, as well as for archival purposes (evidence) based on a legitimate interest.

The recipients of the supplier's data may consist of companies providing services at the request of VGP, to whom VGP will commission activities requiring data processing in the field of IT services, call centers, auditors, legal advisors also postal companies, courier companies, group companies, including Volkswagen AG, authorized public administration bodies.

The data will be kept for the duration of the purchase order placement procedure or for the duration of the contract concluded with the supplier and thefulfillment of the purchase order and later for the period during which claims related to that contract / purchase order / proceeding may arise and for other purposes based on legitimate interest for time necessary to complete them (validity period or pending submission of objections). In the absence of the contract / order placement / participation in the proceedings, the data will be stored for no longer than 5 years from the end of the year in which the registration was made in the purchasing system or until the objection is filed.

The suppliers have the right to access their personal data and the right to rectify, erase personal data, limit processing, the right to transfer data. The suppliers have the right to object to the processing of data in connection with the objectives based on the legitimate interest of VGP. The above rights may be exercised by writing to VGP to the address of the registered office or electronically to the following address: . The supplier has the right to lodge a complaint to the President of the Office for Protection of Personal Data.

For the purpose of undertaking cooperation, the supplier provides personal data of the contact person, based on the legitimate interests of VGP and the supplier. The supplier undertakes to provide employees / co-workers whose personal contact details have been disclosed to VGP, with information regarding the processing of such data by VGP, in accordance with the VGP guidelines.

5.TERMS AND CONDITIONS OF COOPERATION:

Payment deadline is ..... days from the day of the invoice delivery to the Volkswagen Group Polska headquarters. VGP doesn’t accept terms of payment shorter than 30 days.

Currency of payment ......

By submitting an offer to Volkswagen Group Polska or executing an order the General Terms of Purchase of Volkswagen Group Polska corresponding withthe type of contract available at

______

(stamp, signature: name and surname)date

Please send the filled form via e-mail (scanned document):

e-mail:

 Volkswagen Group Polska. Wszelkie prawa zastrzeżone