Alternative dispute resolution for consumer disputes (ADR) Alternative dispute resolution for consumer disputes (ADR) If you wish to initiate a procedure concerning an out-of-court resolution of a consumer dispute (ADR), you may fill in an online form and attach relevant documentation, in particular the proof of your unsuccessful attempt to resolve your dispute with the trader. Please note that once this online form will be successfully sent, you will receive a confirmation e-mail to your mail box. Please print the confirmation you will receive in this e-mail, sign it and send it by post to us within 10 days. If you have a certified digital signature, you may also send this confirmation to us by e-mail using that certified digital signature. If you have a Data box, the confirmation may also be returned to our Data box address x7cab34. In case you are represented by another person, power of attorney needs to be provided too. en Consumer details Name: Surname: Address: Postcode: City: Country: AustriaBelgiumBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUnited KingdomOther E-mail: Phone: Data box: Consumer has representative Consumer representative details Representative type: Please pick from selectNatural personJuridical person Name: Surname: Name: Address: Postcode: City: Country: AustriaBelgiumBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUnited KingdomOther E-mail: Phone: Data box: Trader details Country: AustriaBelgiumBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLithuaniaLuxembourgMaltaNetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUnited KingdomOther Trader type: Please pick from selectNatural personJuridical person Trader name: Trader surname: Company registration number: Fill from ARES For Czech traders you can use ARES for automatically filling the data Company name: Address: Postcode: City: E-mail: Phone: Data box: Complaint Problem category: Please pick from selectConsumer GoodsGeneral Consumer Services Financial ServicesPostal services and electronic communicationsTransport servicesLeisure ServicesEnergy and WaterHealthEducationOther Specify problem category: Food - Fruit and vegetablesFood - MeatFood - Bread and Cereals Food - Health food and nutrients Food - Other Non-alcoholic beverages Alcoholic beverages Tobacco Clothing (including tailor-made goods) and footwearHouse maintenance and improvement goodsFurnishingsLarge domestic household appliances (including vacuum cleaners and microwaves)Small domestic household appliances (including coffee machines and food- processing appliances)Electronic goods (non-ICT/recreational)Information and communication technology (ICT) goodsLeisure goods (sports equipment, musical instruments, etc)New carsSecond-hand carsOther personal transportSpares and accessories for vehicles and other means of personal transportFuels and lubricants for vehicles and other means of personal transportBooks, magazines, newspapers, stationery (excluding postal delivery)Pets and pet goodsElectrical appliances for personal careCosmetics and toiletries for personal careJewellery, silverware, clocks, watches and accessoriesBaby and child care articlesCleaning and maintenance products, articles for cleaning and non-durable household articlesPet servicesReal estate servicesConstruction of new housesHouse maintenance and improvement servicesHouse removal and storageHouse cleaning servicesPersonal care servicesCleaning, repair and hiring of clothing and footwearSupport, research and intermediary servicesMaintenance and repair of vehicles and other transportLegal services &Funeral servicesChild careFinancial Services - Payment account and payment servicesFinancial Services - Credit (excluding mortgage/home loans)Financial Services - Mortgages / Home loansFinancial Services - SavingsFinancial Services - OtherInvestments, pensions and securitiesNon-life Insurance - Home and propertyNon-life Insurance - TransportNon-life Insurance - TravelNon-life Insurance - Health, accident and otherInsurance - LifePostal services &Fixed telephone servicesMobile telephone servicesInternet servicesTelevision servicesOther communication servicesTram, bus, metro and undergroundRailwaysAirlinesTaxiSea, river, other water transportTransport infrastructure servicesRental servicesHotels and other holiday accommodationPackage travelTravel agency servicesTimeshare and similarRestaurants and barsServices related to sports and hobbiesCultural and entertainment servicesGambling, lotteriesOther leisure servicesWaterElectricityGasOther energy sourcesPrescribed medicationOver-the-counter medicationMedical devices and other physical aids used by patientsHealth servicesRetirement homes and home careSchoolsLanguage, driving instruction and other private coursesOther (Includes both goods and services) Selling method: Please pick from selectFace-to-face: Supermarket, hypermarketFace-to-face: Discount storeFace-to-face: Department storeFace-to-face: Retail chain storeFace-to-face: Retail storeFace-to-face: Small shop, small storeFace-to-face: Greengrocer, night shopFace-to-face: Street market, farm shopFace-to-face: Petrol stationFace-to-face: Office (includes banks and other financial institutions)Face-to-face: Travel agency, tour operator agencyFace-to-face: Hospital, clinic, surgeryFace-to-face: SchoolFace-to-face: Sports and leisure premisesFace-to-face: Other type of premisesElekronický obchod (INTERNET mimo i-net aukce)Mobile commerceMarket, trade fairAuctionsInternet auctionsSelling away from business premises (off-premises)Other selling methodsDo not knowDistance selling (e.g. phone, post), excluding e-commerce, mobile commerce and internet auctions Nature of complaint: Please pick from selectDefective, caused damageNot in conformity with orderNot delivered / not providedIncorrect invoice / bill Warranty / statutory guarantee not honouredOther issues related to contracts and sales Proposed solution: Brief case description: It is necessary to try to resolve the dispute with the trader first. Have you contacted the trader concerning the problem? YesNo When did you contact the trader?: I declare that that no court judgement or an arbitration decision have been issued in this dispute, that no agreement in an out of court resolution scheme has been concluded in this dispute, and that the dispute is not subject to any ongoing court proceedings, arbitration or an out of court resolution procedure other than the one initiated by this petition. Document of attempt to solve the problem with the trader: Maximum size of all attachments is 10 MB, valid file types are - pdf, jpg, jpeg, png, doc, docx, xls, xlsx, ppt, pptx, odt. Attachments: *Marked form fields are required. This out of court dispute resolution procedure is subject to the relevant provisions of the Consumer Protection Act and Procedural Rules established by the Czech Trade Inspection Authority. × Successfully sent