REGULATIONS FOR THE PURCHASE OF GOODS AND TICKETS ONLINE

• REGULATIONS FOR THE PURCHASE OF GOODS AND ONLINE TICKETS
• REGULATIONS PERMANENT EXHIBITION

REGULATIONS FOR PURCHASING GOODS AND TICKETS ONLINE MUSEUM OF JAN PAWEŁ II AND PRIMATE WYSZYNSKI

I. Glossary

Whenever the Regulations refer to
1) Museum/Module Operator - should be understood as Mt 5,14 | Museum of John Paul II and Primate Wyszynski with headquarters in Warsaw, Prymas Augusta Hlonda 1, 02-972 Warsaw, mailing address: al. Rzeczypospolitej 1, 02-972 Warsaw, entered in the register of cultural institutions kept by the Minister of Culture and National Heritage under the number RIK 96/2016;
2) Module - it should be understood as a module of the Museum's website designed for the purchase of goods and online tickets for Events at https://sklep.mt514.pl;
3) Museum ticket office - it should be understood as the ticket office located in Mt 5,14 | Museum of John Paul II and Primate Wyszynski, 1 Prymas Augusta Hlonda Street, 02-972 Warsaw;
4) Event - shall be understood as workshops, educational activities, temporary exhibitions, special events, etc., as well as guided group tours or individual tours covering the museum premises open to the public and taking place according to the
according to the dates indicated on the ticket and in accordance with the tour regulations available at https://sklep.mt514.pl;
5) Rules and Regulations - shall mean these rules and regulations for the purchase of goods and individual and group tickets online for Museum Events through the Module, by telephone or electronically, together with any amendments thereto made in accordance with its provisions by the Museum;
6) Order - it should be understood as an order for tickets/tickets for Events
for individual guests and for groups and merchandise;
7) Orderer/Customer - shall mean an individual and/or legal entity purchasing goods and/or individual and/or group tickets online, by phone or electronically for Museum Events;
8) Ticket - shall mean a document in the form of a printout or a readable .pdf file presented on the screen of a mobile device, entitling the holder to use the Event on the specified date and time
and time, containing the fee for the Event, as specified on the Ticket, being at the same time a document confirming the conclusion of the contract;
9) Merchandise - should be understood as Museum publications, i.e. books, posters, souvenirs and other products related to the statutory activities of the Museum.

II. General provisions

1. These Regulations set out the detailed conditions for the purchase of goods, individual and group tickets online, by phone or electronically for Events at the Museum.
2. The Museum shall provide services for the purchase of goods, individual and group tickets online, by telephone or electronically in a manner consistent with the provisions of these Regulations. The Museum reserves the right to amend and update the content of the Regulations. At the same time, any change to the Terms and Conditions will be communicated to the Ordering Party by posting information about the change in the Module and posting the amended Terms and Conditions in the Module. The parties are bound by the version of the Terms and Conditions in effect at the time of placing an order, any changes to the Terms and Conditions do not shape the rights of the Ordering Party under orders placed before the changes.
3. Immediately after ordering goods or tickets online, by phone or by email, the Ordering Party will receive from the system a confirmation of the Order sent by email to the email address provided by the Ordering Party indicating the order number, the number of tickets and/or goods ordered, the subject of the Event for which the tickets were ordered, the date and time of the Event and the value of the tickets and/or goods ordered.
4. Before using the process of purchasing tickets and/or merchandise through the Module, the Ordering Party should read the Terms and Conditions and confirm that he/she has read them
and acceptance of its contents by checking the appropriate box in the window that opens automatically in the Module, and then complete registration (either with or without creating an account).
5. In order to purchase tickets and/or merchandise through the Module, the Ordering Party should have a Microsoft Edge, Mozilla FireFox, Opera, Google Chrome or Safari browser
in the current version.

III. Purchase goods and/or individual and/or group tickets online

1. The purchase of goods and/or individual and/or group tickets can be made online
via the Module.
2. The purchase of group tickets, previously ordered electronically/telephonically, can be made online, after receiving a specially generated payment link to the e-mail address provided in the order process. This link will direct the ordering party to the PayU service.
3. To purchase merchandise and/or tickets through the Module, you must complete the purchase form and follow the instructions in the Module. The Museum requests that you fill out the form carefully and completely. Failure to follow the instructions in the Module may result in the inability to successfully purchase a ticket and/or merchandise.
4. When purchasing goods and/or tickets online, payments are made by electronic transfer or payment card.
5. Tickets and/or merchandise shall remain the property of the Museum until the Museum records confirmation of payment by the Purchaser's Bank.
6. Payment unconfirmed by the Ordering Party's Bank within 20 minutes of placing the order will result in automatic cancellation of the order, of which the Ordering Party will be informed in a separate email.
7. The time for payment for the Order may be extended when placing the Order by phone or e-mail, whereby exceeding the established payment period also results in automatic cancellation of the Order.
8. Payments for tickets are handled exclusively by PayU S.A., based in Poznan, 182 Grunwaldzka St., through the payu.pl Internet portal. Failure to provide the bank confirmation referred to in section 6 and section 7 above will result in the money collected by the payment operator being automatically returned to the Orderer's bank account. The Ordering Party will be informed about the procedure in such a situation via e-mail by the payment operator - the company PayU S.A., owner of the payu.pl portal, who should then be contacted directly by sending an e-mail to: pomoc@payu.pl or calling: (+48) 61 630 60 05.
9. In accordance with the Decree of the Minister of Finance of December 17, 2024 on exemptions from the obligation to keep records of sales using cash registers (Journal of Laws of 2024, 1902poz. 930), the sale of goods and tickets in terms of ordering and payment via the Internet is not subject to fiscalization, so the Purchaser does not receive a fiscal receipt.
10. The prices of goods and tickets include VAT. In order to receive a VAT invoice, please select the option - VAT invoice - in the ordering process and provide the correct data necessary for its issuance.
11. The purchaser who has purchased tickets entitling to a discount in the online sales system is required to show the document entitling to the discount before entering the Event for which the tickets were purchased. Tickets without documented entitlement to a discount do not entitle the holder to enter
to the Event and are not refundable.
12. Once the online purchase has been paid for and the payment has been credited in accordance with paragraph 3 and paragraph 5 above, the ticket will be sent to the email address provided as a pdf attachment. Please immediately verify the correctness and compliance of the ticket with the order, in particular the amount, type of Event, its date and time. Purchased goods, depending on the selected method of delivery, will be sent by courier within 5 working days or will be available for personal collection at the Museum's Box Office.
13. A ticket printed or saved on a mobile device shall be subject to verification prior to entering the to the Event and constitutes a title to participate in the Event (subject to the provisions of paragraph 11 above). In the case of an electronic ticket, please ensure that your mobile device has software installed that properly displays PDF files. In order for the ticket to be successfully scanned from the mobile device, the brightness of the display screen must be set to maximum.
14. The Museum reserves the right to refuse admission to the Event if the ticket is damaged or illegible, and verification of the barcode is impossible.
15. An ordering party purchasing tickets online is required to abide by the Terms and Conditions of the tour, the content of which can be consulted directly at the Museum or on its website: https://sklep.mt514.pl.
16. The inability to purchase individual tickets through the online sales system does not mean the inability to purchase tickets at the Museum Box Office, as long as tickets for Events are still on sale.

IV. Procedure for purchasing goods

1. Information about goods given on the website of the Store https://sklep.mt514.pl, in particular their descriptions, technical and performance parameters and prices, constitute an invitation to conclude a contract within the meaning of Article 71 of the Civil Code and are not binding until the Seller confirms the order.
2. The Store's offer is limited to the territory of the Republic of Poland.
3. Deliveries outside the Republic of Poland are not made, but orders can be placed from other countries.
4. Placing an order means correctly filling out the "Order Form" located on the Store's website - https://sklep.mt514.pl. The Museum is not responsible for incorrect completion of the form, or incorrect payment by the Customer.
5. The order sent by the customer constitutes a statement of intent to conclude a sales contract.
6. As confirmation of receipt of the order by the Museum, the customer receives an electronic confirmation of acceptance of the order for processing. Lack of such confirmation is equivalent to non-acceptance of the order for processing. Any doubts should be clarified electronically by contacting the Museum sklep@mt514.pl or by phone at 22 308 14 91.
7. Orders can be placed 24 hours a day throughout the year. Order placed after 2 pm on weekdays, Saturdays, Sundays and holidays will be processed on a first-come, first-served basis
starting at 8 a.m. on the next business day. In the case of orders containing a larger number of products, the Museum reserves the right to process them within a longer period of time than provided for in the
in the Terms and Conditions, after informing the Client by e-mail to the Client's e-mail address.
8. In the case of shipment of Goods against cash on delivery, recording, securing, making available and confirming to the Customer the material provisions of the contract shall be done by attaching a sales document to the shipment containing the goods.
9. In the case of payment for the Goods online, confirmation to the Customer of the material terms of the contract is made by e-mail to the address provided by the Customer. The sales document is attached in the email.

V. Payment, order processing for goods

1. The condition for the execution of the order is the correct completion of the form located at https://sklep.mt514.pl and the fulfillment of the conditions described in Chapters II, III and IV of the Regulations.
2. When placing an order, the customer should choose one of the available means of payment:
PayU (card, BLIK, quick transfer, traditional transfer);
3. All prices presented in the Store are expressed in Polish zloty and are gross prices - they include VAT. The price presented next to a given product is binding for the Customer at the time of placing an order. Prices do not include delivery costs.
4. The price stated in the order confirmation is binding on the Parties. Some of the offered products may be unavailable at the moment, of which the Customer will be informed by the Museum to the Customer's email address.

VI. Shipping and receiving orders

1. Orders are processed within 2 to 5 business days from the date the payment is credited to the Museum's account. This deadline does not include the time required for delivery.
2. Orders are shipped via courier, inPost parcel service or the Polish Post Office. When approving the order, the customer chooses the form of payment and shipping. The cost of shipping within Poland is given when creating the order and is added to the order amount.
3. The delivery period is a maximum of 30 days. If the goods are unavailable at the time the order is placed, the customer has the right to withdraw from the contract and the Museum returns the payment to the customer within 14 days. If the ordered product is in the Museum's warehouse at the time the order is placed, the delivery period is a maximum of 14 working days. Delivery charges are calculated individually for each item and are listed during the ordering process. When the customer receives the shipment, he/she has the right to check the completeness of the contents of the shipment
and if mechanical damage or incompleteness of the contents of the shipment is found, a damage protocol should be written in the presence of the courier or an employee of the Polish Post Office. The protocol should be drawn up in two identical copies and signed by the courier or employee of the Polish Post and the Customer. After drawing up the protocol, you should send information about the situation without undue delay to the e-mail addresssklep@mt514.pl. Preparation of the protocol will speed up and facilitate the process of claiming transport damage. Lack of protocol does not limit the Customer to file a claim within the statutory period.

VII. Procedures for claiming goods

1. The Museum shall be liable to the Customer for non-conformity with the contract of goods purchased by that Customer under the terms of the Civil Code Act, the Consumer Rights Act of May 30, 2014 (Journal of Laws of 2024, item 1796). The warranty period is 2 years.
2. Complaints in writing should be addressed to the Museum's address: Museum of John Paul II and Primate Wyszynski, 1 Rzeczypospolitej Avenue, 02-972 Warsaw with the annotation "Online store".
3. In the complaint, the customer should provide his name, mailing address, confirmation of purchase, type and date of non-conformity of the goods with the contract.
4. The Museum is obliged to consider the complaint within 14 days of its receipt.
5. The Museum shall not be liable for damages resulting from misuse of the offered goods, unless the goods have been used in a manner inconsistent with their intended use. The provision in question does not limit the consumer's rights under the warranty.
6. Complaints about the provision of electronic services:
1) The Museum takes steps to ensure the fully correct operation of the Store's website, to the extent that results from current technical knowledge, and undertakes to remove within a reasonable time any irregularities reported by Customers;
2) The customer should immediately notify the Museum of irregularities or interruptions in the in the functioning of the Store's service;
3) irregularities related to the functioning of the Store, the Customer may report by e-mail sklep@mt514.pl;
4) In the complaint, the Customer should provide his name, mailing address, type of and date of occurrence of irregularities related to the functioning of the Store.

VIII. Eligibility and procedures for withdrawal from the contract of purchase of goods

1. The customer has the right to withdraw from a contract concluded at a distance, without giving any reason, by submitting an appropriate statement in writing - a sample of which can be found under the Regulations - within 14 days, sending it to the Museum's address by e-mail sklep@mt514.pl or to the address of the headquarters of the John Paul II and Primate Wyszynski Museum,
Al. Rzeczpospolitej 1, 02-972 Warsaw. The 14-day period is calculated from the date of receipt of the goods by the customer.
2. In order to exercise the right of withdrawal from the sales contract, it is sufficient to send a statement of exercising this right before the expiration of the withdrawal period indicated above. The customer may use the form attached hereto as Appendix 1.
3. In the case of withdrawal from the contract of sale by the Customer, the John Paul II and Primate Wyszynski Museum is obliged to return to the Customer immediately, but no later than within 14 days from the day of receipt of the Customer's statement of withdrawal from the contract of sale, all payments received from the Customer, including the costs of delivery (except for additional costs that may arise due to the choice by the Customer of a different method of delivery
than the cheapest ordinary delivery method offered by the Store). The same means of payment used by the Customer during the purchase transaction shall be used to return the payment, unless
unless the Store explicitly agrees with the Customer on a different means of payment. The Store will not charge the Customer any fees for this. The Museum may withhold a refund of a payment received from the Customer until it receives the returned goods or until the Customer provides proof that the goods have been shipped to the John Paul II and Primate Wyszynski Museum, whichever occurs first. All payment refunds are made automatically to the bank account number used by the Customer for payment. In the case of payment by credit card, refunds will be made to the credit card account.
4. Immediately upon receipt of the Customer's statement of withdrawal from the sales contract, regardless of whether it was made by mail or in the electronic form provided for in paragraph 3 above, the Store will confirm receipt of the Customer's statement.
5. Withdrawing from the contract of sale of goods, the Customer is obliged to immediately return the purchased goods to the address: Museum of John Paul II and Primate Wyszynski, Al. Rzeczpospolitej 1, 02-972 Warsaw, but no later than within 14 days from the day on which the Customer made a statement of withdrawal from the contract of sale. The deadline is considered to have been met if the goods were sent before the expiration of 14 days.
6. The customer is liable for diminution in value of the goods only to the extent resulting from
from use beyond what is necessary to ascertain the nature, characteristics and functioning of the thing. For the purpose of ascertaining the nature, characteristics and functioning of the thing, the customer may normally open or unpack the package to check the characteristics and functioning of the thing and examine the
it in the manner customary in stationary stores.
7. Acceptance of the Terms and Conditions by the customer does not limit his right to obtain full information
about the withdrawal procedure in a permanent form before placing the order.

IX. Complaints about the online ticket purchase process and the quality of services provided by the Museum

1. The purchaser may file a complaint regarding the process of purchasing tickets on-line and the quality of services provided by the Museum by sending an e-mail to: sklep@mt514.pl or writing
to Mt 5,14 | Museum of John Paul II and Primate Wyszynski, 1 Rzeczypospolitej Avenue, 02-972 Warsaw, with the annotation Complaint, within 14 (fourteen) calendar days from the day on which the event covered by the complaint occurred.
2. In the complaint, the Ordering Party should indicate: what the complaint concerns, provide the order number and the reason for the complaint, but the Museum is not responsible for incorrectly made complaints, in particular for the provision of incorrect or false data by the Ordering Party.
3. The Museum is also not responsible for non-delivery of a message if it is stopped by the Ordering Party's email system's anti-spam system.
4. The complaint will be considered by the Museum within 14 (fourteen) calendar days
from the date of receipt of the complaint by the Museum. The Museum will inform the Ordering Party of the result of the complaint review in writing or by email to the address indicated in the
in the complaint immediately after considering the complaint.
5. Consideration of a complaint by the Museum does not exclude the right of the Ordering Party to pursue claims under the general rules of the Civil Code and the provisions of the Consumer Rights Act of May 30, 2014 (Journal of Laws of 2024, item 1796).

X. Return and exchange of tickets

1. In the event that an Event does not take place for reasons attributable to the Museum, the Museum will accept returns of tickets purchased online and refund the amount paid
based on the provisions of paragraph 2 below.
2. Refunds for the reasons referred to in paragraph 1 above for tickets paid at the Museum Box Office may be made only at the Museum Box Office.
3. Purchased tickets are not refundable or exchangeable for tickets at another price or for another Event or another date of the Event, subject to the provisions of paragraph 1 of this Section.
4. Being more than 15 (fifteen) minutes late from the start time of the Event indicated
on the ticket or in the email confirming the Order, will result in inability to participate in that Event.
5. Pursuant to the content of Article 38 para. 12 of the Act of May 30, 2014 on Consumer Rights (i.e., Journal of Laws 2024, item 1796), the right of withdrawal from a contract concluded remotely does not apply to the consumer
with regard to services related to Cultural Events, if the contract specifies the day or period of service provision.

XI. Data protection

1. During the process of purchasing merchandise and/or tickets online, either by phone or electronically to a designated e-mail address, the Purchaser will provide the Museum with his/her personal information.
2. ADMINISTRATOR - The administrator of the personal data collected for the contract is Mt 5,14 | Museum of John Paul II and Primate Wyszynski with its registered office in Warsaw, Prymas Augusta Hlonda 1, 02-972 Warsaw, mailing address: al. Rzeczypospolitej 1, 02-972 Warsaw, entered in the register of cultural institutions kept by the Minister of Culture and National Heritage under the number RIK 96/2016, NIP 9512414063 and REGON 364481345.
3. DATA PROTECTION INSPECTOR - A data protection officer has been appointed at the Museum,
who can be contacted on all matters relating to the processing of personal data and the exercise of rights related to data processing by e-mail: inspektor.rodo@mt514.pl or in writing to the registered office address indicated above.
4. SOURCE OF DATA ORIGIN -Administrator processes data of persons who filled in the Order Form contained in the Module. If a ticket was sent to a person who did not order it through the Purchasing Module, his/her data was provided by the person filling out the Order Form.
5. PERSONAL DATA - The personal data you provide (name or company under which you operate, email address, telephone number, delivery address, tax ID) will be processed for purposes related to the execution of the contract for the purchase of goods and/or online tickets for Events referred to in these Terms and Conditions, as well as after registering an account for the purpose of placing further orders through the use of the Module for the sale of goods and tickets on the website.
6. PURPOSE OF PROCESSING - Personal data will be processed for:
1) To provide services electronically by entering into contracts with the Ordering Party for the sale of goods and/or online tickets ordered by the Ordering Party using the Module and the performance of such contracts, as well as after registration of an account for the purpose of placing further orders through the use of the Module for the sale of tickets on the website (Article 6(1)(b) of the DPA);
2) return of goods and/or tickets and processing of any complaints (the basis for processing is Article 6(1)(b) of the DPA);
3) to fulfill legal obligations, in particular to fulfill financial reporting obligations (the basis for processing is Article 6(1)(c) of the DPA);
4) realization of the administrator's legitimate interest (the basis for processing is Article 6(1)(f) of the RODO), by which is meant:
a) Answers to questions sent by the Ordering Parties via e-mail and telephone,
b) establish, assert or defend claims related to the operation of the Module and the services provided through it.
7. PROCESSING TIME - personal data will be processed until
1) duration of the sales contract between the Purchaser and the Administrator, and after its termination until the expiration of the statute of limitations for claims arising therefrom;
2) with respect to data processed under the legitimate interest of the Administrator, until the Ordering Party raises a legitimate objection,
subject to the next point;
3) Until the expiration of the obligation to store data under the law,
in particular, the obligation to store accounting documents relating to the sales contract.
8. DATA RECIPIENTS - Personal data may be shared:
1) state authorities and other entities authorized to access the data
to the extent and for the purpose prescribed by law;
2) third-party entities providing services to the administrator to support its operation in the scope of services provided, including transportation companies, IT service providers, entities auditing its activities, entities responsible for
for electronic payments.
9. RIGHTS OF PERSONS WHOSE DATA ARE PROCESSED - in connection with the processing of personal data, in cases provided by law, the Ordering Party using the service has the following rights:
1) Access to their personal data;
2) rectify your personal data;
3) deletion of your personal data;
4) Limit the processing of your personal data;
5) portability of your personal data;
6) object to the processing of your personal data;
7) revoke consent to the processing of personal data in a situation where it is the basis for data processing, which, however, does not affect the lawfulness of processing carried out on the basis of consent before its withdrawal;
8) lodge a complaint to the supervisory authority, i.e. the President of the Office for Personal Data Protection - more information on this right is available at: https://uodo.gov.pl/pl/p/skargi.
9) More information on the rights of data subjects is available in Articles 12-23 of the RODO, the text of which can be found at: https://eur-lex.europa.eu/legal-content/PL/TXT/?uri=CELEX%3A32016R0679.
10. VOLUNTARILITY TO PROVIDE PERSONAL DATA - Provision of personal data by Orderers is voluntary, but failure to provide such data will prevent (concerning data indicated
in the Order Form as indispensable) or may hinder (concerning e-mail address, telephone number) the Administrator's provision of electronic services, and thus the Purchaser's purchase of goods and/or tickets online.
11. TRANSMISSION OF DATA TO THIRD COUNTRIES - personal data of those ordering online tickets
through the Module will not be transferred to countries outside the European Economic Area.
12. AUTOMATED PROCESSING, INCLUDING PROFILING - The Administrator will not carry out activities involving automated processing (including profiling) of the Orderers' personal data, which could have legal effects on the Orderers, or otherwise significantly affect them.

XII. Final provisions

1. Tickets purchased at the Museum Box Office and online cannot be copied, altered.
2. The Museum is not responsible for the functioning of the Internet network through which goods and tickets are purchased. The Museum is not responsible for messages or other data lost or misplaced on the Internet, individual computer settings and the way they are configured, as well as settings or service interruptions occurring
at Internet access providers.
3. If you notice any irregularities in the operation of the Online Merchandise and Ticket Purchase Module, located at www.sklep.mt514.pl, please contact us immediately at the following e-mail address: sklep@mt514.pl.
4. The Museum is not responsible for tickets damaged or lost by the Ordering Party.
5. When purchasing goods and/or tickets online, the purchaser is required to read
with these Terms and Conditions, to provide truthful data, as well as not to send any unlawful content.
6. Making online ticket purchases through the Module does not involve any costs other than the cost of connection to the Internet or telephone operator, which cost shall be borne by the Ordering Party, in accordance with the rates of the Internet provider or operator whose services the Ordering Party uses. The purchase of goods may involve delivery costs, depending on the selected method of delivery of the goods.
7. These Terms and Conditions for the purchase of goods and/or tickets online are available at and at the Museum Box Office.
8. Settlement of possible disputes arising between the Museum and the Customer shall be submitted to the competent courts in accordance with the provisions of the relevant provisions of the Code of Civil Procedure.
9. In matters not covered by these Regulations, the provisions of the Civil Code, the provisions of the Act of May 30, 2014 on consumer rights and other relevant provisions of Polish law shall apply.

 

Appendix 1

INFORMATION ON EXERCISING YOUR RIGHT OF WITHDRAWAL MODEL INSTRUCTIONS ON WITHDRAWAL FROM THE CONTRACT

You have the right to withdraw from this contract within 14 days without giving any reason.
The withdrawal period expires after 14 calendar days from the date of receipt of the goods.
To exercise your right of withdrawal, you must inform the John Paul II and Primate Wyszynski Museum
and Primate of Wyszynski about your decision to withdraw from this agreement by an unequivocal statement (for example, a letter sent by mail to the address of the Museum of John Paul II and Primate of Wyszynski
Al. Rzeczpospolitej 1, 02-972 Warsaw or by e-mail sklep@mt514.pl.
You can use the model withdrawal form, but it is not mandatory.
In order to comply with the withdrawal period, it is sufficient for you to send information concerning the exercise of your right of withdrawal before the expiry of the withdrawal period.
In the event of withdrawal from this contract, we will return to you all payments received from you, including the costs of delivery of the items (except for the additional costs resulting from the delivery method chosen by you other than the cheapest ordinary delivery method offered by us), immediately and in any case no later than 14 days from the day on which we are informed
of your decision to exercise your right of withdrawal from this contract.
We will refund your payment using the same means of payment that you used in the original transaction, unless you have expressly agreed otherwise; in any case, you will not incur any fees in connection with this refund.

 

 

WITHDRAWAL FORM

Place, date
Name and surname
Address of residence
Museum of John Paul II and Primate Wyszynski
Al. Rzeczpospolitej 1
02-972 Warsaw

Declaration of withdrawal from a contract concluded at a distance
I declare that I withdraw from the contract (enter details of the purchase, e.g. order number, invoice, receipt ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . purchased on . . . . . . . . . . . . . . . .
I request a refund of the amount . . . . . . . . . . . . . . . . zł
(in words: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .)
to account no . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Customer signature