I hereby declare that I have been informed and unconditionally
accept that by filling and sending this EURO26 Card order and making the
payment- 21 PLN of which is the member fee of the Polish Youth Card Association
in Gdańsk, I become an associate member of the Polish Youth Card Association in
I hereby declare that the above data is truthful and allow it to be
processed by the Polish Youth Card Association in accordance with the act on
personal data protection and the aims of the Association, as well as to be
shared with Impact sp. z o.o., Youth Projects Managements Sp. z o.o. and AXA
Ubezpieczenia Towarzystwo Ubezpieczeń i Reasekuracji S.A. in order to enter and
execute an insurance agreement on my account. All data is submitted voluntarily
and I am allowed to access and modify them. I have read the Association's
Statute and the EURO26 Holder Terms and Conditions, as well as the Insurance
Terms and Conditions of AXA Ubezpieczenia Towarzystwo Ubezpieczeń i Reasekuracji
S.A. and accept them and permit to be executed in relation to myself.
I hereby allow every medical professional to inform AXA Ubezpieczenia Towarzystwo Ubezpieczeń i Reasekuracji S.A. about my health and make accessible any documents on the course of my treatment necessary to validate my insurance claim.
I hereby declare that I allow being protected by the insurance
provided by AXA Ubezpieczenia Towarzystwo Ubezpieczeń i Reasekuracji S.A. and
am aware that the insurer is Impact sp. z o.o. in Gdańsk and the insurance
agent is Youth Projects Management sp.z o.o. in Gdańsk.
I hereby declare that with accordance to the act on personal data
protection of 29 August 1997 (Dz. U. [Journal of Laws] No. 133, item 883), I
have been informed about the following:
a) my personal data is administered by:
- Polish Youth Card Association, located in Gdańsk, Długi Targ 11/12,
which I am a member of
- Impact sp. z o.o. located in Gdańsk, Sobótki str. 13/2
- Youth Projects Managements Limited Liability Company, located in Gdańsk, Sobótki str. 13/2
b) I have the right to access my personal data, correct and supplement them in accordance with the actual state of matters.
c) I hereby agree to receive information, offers (including trading
offers) from Youth Projects Managements sp. z o.o. in Gdańsk, Polish Youth Card
Association in Gdańsk also via e-mail, sms and voice transmission and direct
With accordance to the act of August 5th 2015 about dealing with complains by institutions of the financial market, we inform, that the rules of filing and dealing with complains are available at: www.axa.pl/reklamacje.