Removal

Request Form

To request the removal of your records complete the form below.
Sign and mail this form with a photocopy of one of your Utility Bill.

Your Information
Last Name

First Name

Phone Number

Street Address

City

State / Province

Postal Code

Country

Email Address

Record Information
Web addresses (URLs) where your records are shown:

1. ____________________________________________________________
2. ____________________________________________________________
3. ____________________________________________________________
4. ____________________________________________________________
5. ____________________________________________________________

Your Signature

Date Signed

411Numbers HK Limited
Removal Request Form version 20151003

NOTICE

1. Incomplete forms will not be processed.

2. Requests mailed without a clear Utility Bills copy will not

be processed.

3. We need to see your name and address on the Utility Bill.

If the address does not match the record we have for you
online, explain the reason on a different page and add it to
your request.

4. Once we process your request we will destroy (shred) this

form and the copy of your Utility Bill.

5. Allow up to 4 weeks for processing.

Mailing Address
411Numbers Limited
Borsigstr. 9
10115, Berlin
Germany

411Numbers HK Limited
Removal Request Form version 20151003