Complaint form

(filled by the optician’s)
ComplaintPart purchase







Claimed part: (Required)

FrontRight templeLeft templeBoth templesFlexDecorative elementLensClip-onWholeOther
Reason for the complaint: (Required)
Broken templeChippingUnsolderingCrackLoss of colourScratchCrookedDamaged threadOther

Is it enough to replace the flex

YESNO

Attach photo (Required)

I agree to the processing of my personal data in accordance with the contents of the General Regulation on the Protection of Personal Data of 27.04.2016 and in accordance with the Act of 18.07.2002 on the provision of electronic services (Dz.U. No 144, item 1204, as amended) by IQ Prisma sp. z o.o. with its registered office at ul. Turawska 14A, 46-022 Zawada for the purpose and to the extent necessary for the preparation and transmission of the complaint application sent to the controller using the above complaint form.

We would like to inform you that the controller of the personal data provided by you is IQ Prisma sp. z o.o. with its registered office at ul. Rodziewiczówny 4, 45-348 Opole (KRS 0000465835, NIP 7543073277, REGON 161535696). In addition, we inform that: Your personal data will be processed by IQ Prisma Sp. z o.o. in order to prepare an answer to the question asked via the contact form, on the basis of your consent (i.e. Article 6(1)(a) of the General Data Protection Regulation). Your personal data will be processed until a reply is provided. You have the right to request access to, rectification, erasure or restriction of processing of personal data concerning you and the right to object to processing, as well as the right to data portability. Furthermore, you have the right to withdraw your consent at any time. The above does not affect the lawfulness of the processing carried out on the basis of your consent before its withdrawal. In addition, you have the right to lodge a complaint with the supervisory authority, the President of the Personal Data Protection Office. The provision of personal data by you is voluntary, but necessary in order to reply. Your data will not be processed by automated means.
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