This form requires between 5 to 10 minutes to be filled out correctly. You can save it at any time and resume later using the save function displayed at the bottom of the page. "*" indicates required fields Your InformationWho are you?* First Last Your name, even if you are sending a request on behalf of a third party. If you represent a third party, you must be legally authorized to act on their behalf.Contact Email* In case we need to contact youYour Role* You are intervening for: A company A individual Both Information Regarding the IndividualWho is the individual concerned? Myself Someone else What is their name?* First Last Their role* Information Regarding the CompanyCompany Name* Company Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Company Identification Number A number that clearly identifies the company.Does this company currently have a website?* Yes No URL of the website's legal notice* Here, you need to indicate a specific page of the website that displays the legal notice where the identity of the company can be confirmed.Content to ModerateThis section must be completed carefully in order to bring the potentially illicit content to our attention with precision. The more specific the details are, the higher your chances are that the content will be modified or removed.List of Contested Contents Which content is targeted by your request? Precise identification of the content to be removed Have you contacted the author? Actions Edit Delete There are no contenus contestés. Add contenu contesté Maximum number of contenus contestés reached. Declaration on HonorFor reference, article 6.1.4 of the LCEN: It is punishable by a penalty of one year’s imprisonment and a fine of 15,000 Euros for any person to present content or an activity to platforms as being illegal with the intent of having it removed or stopping its dissemination, while knowing this information to be inaccurate.I declare on my honor and believe in good faith that the identified content(s) is/are illegal.* Check the box to confirm To my knowledge, the information I have provided above is accurate.* Check the box to confirm SignatureSignature* By typing your full name below, you provide us with your digital signature, which has the same legal value as your handwritten signature. For your request to be considered, your signature must exactly match the first and last name you indicated at the top of this form.EmailThis field is for validation purposes and should be left unchanged. Δ