Versio B.V. | NTD form
Version 1.0 | June 2021

Notice & Takedown form•

By completing this form and sending it to us, you can report a complaint about material orinformation that can be found on our website or a website hosted by us.

•We will handle your complaint as soon as possible, though no later than within seven working
days, where necessary in consultation with an external advisor.

•In the event of an emergency, we will handle the complaint within 48 hours to prevent furtherdamage. We decide ourselves whether an urgent report has been made.

•We will only process complaint forms that have been fully and truthfully completed.

•We will only use your personal data in order to handle the complaint and will retain your data
only for the duration of the processing.

Please enter the following details
1. Surname, first name:
2. Address:
3. Place of residence:
4. Email address:
5. Telephone number:
6. Name of company or body (if applicable):
7. Website to which the complaint pertains:
8. You are:
A user of a website hosted by us
A parent of a user under the age of 16 of a website hosted by us
A copyright holder of a copyrighted work published on a website hosted by us
A holder of a published trademark (proof of registration number) published on a website
hosted by us
Other, namely:

Page 1 of 3

Versio B.V. | NTD form | Version 1.0 | June 2021
Evidence
Always provide as much evidence as possible with your complaint, such as:•a URL;•a different description of the material you are complaining about;•if applicable, the name/alias/username of the person who has posted the material;•a screenshot.

What are you demanding?
That the material be removed/blocked
To be provided with the name and address details of the website holder
That we respond to the publication on the Website
Other, namely:

What is the nature of the Complaint?
Infringement of copyright, trademark right, trade name right or other right of the person making thereport
Racist statement, hate speech or discriminatory statement
Slander or defamation of or insult or threat towards the person making the report
Violation of privacy or portrait rights of the person making the report (including stalking)Child pornography or other illegal pornographic publication
Image or text of pornographic nature or otherwise with sexual overtones
Computer crime (hacks, viruses, etc.)
Publication of your personal data without your consent

Page 2 of 3

Versio B.V. | NTD form | Version 1.0 | June 2021
Other, namely:

Explanation of the report (open text)(Where the report concerns a breach of a right)
You declare that you are the party entitled to the right with regard to which an infringement has beencommitted or that you have been authorised to act on behalf of the rightholder.
You have tried to approach the website yourself, which gave the following reason not to intervene(also indicate if there was no response to your report):

Is this an urgent report?
A report is only considered urgent if the unlawful or undesired information is unmistakably unlawful andthe presence of the information on the Website causes you a direct and major loss. We will assess yourmotivation, where necessary in consultation with our legal advisers. If this is an urgent report, pleaseprovide reasons for the urgency:

Statement
I have completed the form truthfully, the information provided is correct and I, the person making thereport, indemnify Versio B.V. and will hold Versio B.V. harmless against any liabilities arising from any
information that I have provided in this form being incorrect.

Page 3 of 3