Form of withdrawing the consent of the data subject

Enter the name of the service concerned by the request:
Enter the e-mail address through which you will be able to correspond with us. This is an important information, because we will send you information that concerns you and your privacy to the address you specify, this information is confidential.
In the text field you can (but you do not have to) write the information that you think is necessary for the implementation of your application.
Permitted formats: pdf, png, jpg, jpeg, zip, doc, docx, txt, gif, odt, csv, xlsx, xls, eml
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    User’s verification

    We need to be sure that the application you submit concerns only your data. For this purpose, you must provide information that will identify you as the data subject on the website. This information should be consistent with the information filled in during registration and in the user’s profile. If the data provided below are incompatible or non-exhaustive, the application will be rejected.

    Thank you for submitting the application in electronic form. In order to verify and authenticate the application, please print the following files, fill them in, sign and send to:

    Vice-President of the Management Board – Eliza Durnakowska
    Mobiem Polska Sp. z o.o. sp.k.
    ul. Fabryczna 5a
    00-446 Warszawa

    PDF download form_of_withdrawing_the_consent_of_the_data_subject.pdf PDF download application_for_the_provision_of_data_of_the_data_subject.pdf

    Please note that, due to safety reasons, we will not process requests sent only electronically.


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