Declare my purchase

I want to declare my purchase

Fill out this form if you want to declare you purchase for INPUT.

 

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Personal information

Purchases

MM slash DD slash YYYY
MM slash DD slash YYYY

Total

Drop files here or
Accepted file types: jpg, gif, png, pdf, Max. file size: 12 MB, Max. files: 3.
    Note: if you have more than one receipt, please put them into one document and upload them together.
    Consent*
    This field is for validation purposes and should be left unchanged.