Header / logo of the Origin BU to be applied

Confirmation of Receipt / Declaration of Non-Receipt

(Confirmation of Receipt / Declaration of Non-Receipt)

Please return the completed form to:

(Please return the completed form to)
[place for Origin BU address / details]

Date of dispatch 29/07/22

(date of dispatch)
Parcel number(s) 14-digits
34093113880965
(Parcel number(s) 14-digits)
Sender
Mlle Lola PAN
(Sender)
Sr victor Daniel
Carrer del Cep 10
Receiver’s name + address
Piso 11
(Receiver’s name + address)
08027 Barcelona
España
Receiver’s email
danielthemoredangerous@gmail.com
(Receiver’s email)
Receiver’s phone number
34641952267
(Receiver’s phone number)

Please select:
(Please select)

☐ Legally Binding Confirmation of Receipt

(Legally Binding Confirmation of Receipt)
I / We hereby confirm receipt of the above parcel on (date)      
(I / We hereby confirm receipt of the above parcel on) (date)

☒ Legally Binding Declaration of Non-Receipt

(Legally Binding Declaration of Non-Receipt)

I / We hereby declare that the above-mentioned parcel has not come into my / our possession and has not come into
the possession of a person known to me / us.
(I / We hereby declare that the above-mentioned parcel has not come into my / our possession and has not come into the possession of a person
known to me / us)

Please note that, if you make a false statement in this Legally Binding Declaration, you may be
committing a crime punishable by law.
(Please note that, if you make a false statement in this Legally Binding Declaration, you may be committing a crime punishable by law)

______
Footer of the Origin BU v. 1.0 / English [1]
Date of signing (Date of signing): Name and Position of Signatory: (Name and Position of Signatory)

           

Name of Company: (Name of Company) Signature: (Signature)

           

DPDgroup Legally Binding Declaration V1.0_en [2]