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First name {{errorMessages.FirstName.required}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName.pattern}} {{errorMessages.FirstName}} {{errorMessages.FirstName.pattern}}

Last name {{errorMessages.LastName.required}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName.pattern}} {{errorMessages.LastName}} {{errorMessages.LastName.pattern}}

Email address What address can we email you at? {{errorMessages.MAILBACKADDR.required}} {{errorMessages.MAILBACKADDR.pattern}} Please match the e-mail address above {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR.pattern}} {{errorMessages.MAILBACKADDR}} {{errorMessages.MAILBACKADDR.pattern}}

Country Code {{errorMessages.CALLBACKCLICountry.required}} {{errorMessages.CALLBACKCLICountry}}

Phone number Which number can we call you on? {{errorMessages.CALLBACKCLIPhone.required}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone.pattern}} {{errorMessages.CALLBACKCLIPhone}} {{errorMessages.CALLBACKCLIPhone.pattern}}

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By submitting this form, Proximus, acting as data controller, records the personal data contained in this form in order to contact me regarding the second residence promotion in accordance with my request. My data will not be processed for any other purposes.

My data are processed in accordance with Proximus’ data protection statement, which also informs me how to exercise my rights relating to the protection of my personal data.

I would like to be kept informed about products, services, contests and promotions of Proximus. As the data controller, Proximus may store the aforementioned personal data, along with the context in which it was collected, in its records. This data, together with my interests inferred from the collection context, may be used to personalize communications and to contact me via phone or electronic messaging services (e.g., e-mail, SMS/RCS, WhatsApp, etc.). I acknowledge that I have the right to withdraw my consent at any time and that my data is processed in accordance with the Proximus privacy policy, which informs me how to adjust my privacy settings and how to withdraw my consent.

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