_NOTE: Participation in the promotion is only possible when filling out the form according to the steps below

_Select benefits and add the phone number

_Check the information and confirm

_Thank you for your registration!


_Fill in the fields


_Validate the entered data


_Confirm registration


_Print or save confirmation

{{'_Personal details' | translate}}{{'_Change profile' | translate}}

{{'_First name' | translate}} {{user.FirstName}}
{{'_Last name' | translate}} {{user.LastName}}
{{'_Email' | translate}} {{user.Email}}
{{'_Birth date' | translate}} {{user.BirthDate | date: 'dd-MM-yyyy'}}
_Gender *
{{'_Phone number' | translate}} {{user.PhoneNumber}}
{{'_Address1' | translate}} {{user.Address}}
{{'_Address2' | translate}} {{user.Address1}}
{{'_City' | translate}} {{user.City}}
{{'_Country' | translate}} {{user.CountryName}}
{{'_Zip code' | translate}} {{user.ZipCode}}


({{SamplePrimaryCode}} )

_Contact Number

_Contact Number HelpText

_Mobile number

_Mobile Number Format

_Delivery address



( :   {{SampleSecondaryCode}} )

_Your product information

_Which product did you buy?

{{'_SerialNumber' | translate}}


{{'_IMEI' | translate}}


{{promotion.ChangeEANCodeAsActionCode ? '_ActionCode-EAN' : '_EAN' | translate}}


_(Image or PDF with max size of 7MB)

_Browse {{Products[$parent.$index].MediaUploads[childIndex].UpdloadData.Title == '' ? 'No file selected' : Products[$parent.$index].MediaUploads[childIndex].UpdloadData.Title}}

_Purchase information

_Purchase date

_Purchase location







_Your Gift / Cashback

_Based on the product information provided in the previous step

    • {{product.selectedProductInfo.DisplayName}}  /  {{product.selectedProductInfo.ModelCode}}
  • _You do not seem to qualify for any gift/cashback. Please check the promtion details

    _You are eligible for one of the following gift / cashback


    _Cashback   {{gift.CashBackAmount | currency: currencySymbol}} {{gift.CashBackAmount | currency: currencySymbol}}




    _Gift   {{giftItem.ProductPlusTitle}}



    _Please enter your bank account holder name


    _You can request your IBAN on ibanbic.com


    _Please enter your bank account number


    _Please enter your Sort Code


    _Please enter your SWIFT BIC Code



    _This field is mandatory