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1849 PLC 3M Ukraine A-Group Advertising Agency ABB Ltd ACA Bureau ACUMEN International ADECCO UKRAINE Adizes Institute ADM UKRAINE LLC Advent International Ukraine LLC AECOM AES Ukraine AGCO Corporation Agrimatco-Ukraine CJSC AgriSol Ltd Agro Soul Agroindustrial Trading Company LLC AGROTRADE Group AIR FRANCE-KLM Group in Ukraine Air Liquide Ukraine Aisi Realty Public Limited AKMA, Production and Commercial Firm Albatros-Travel Alcatel-Lucent Ukraine Alekseev, Boyarchukov and Partners ALFA STRAKHUVANNYA IC, PJSC Alfa-Bank (Ukraine), PJSC Alfred C. Toepfer International (Ukraine) Ltd. All Star Realty Allied Carbon Trading Ltd Allseeds Alltech Ukraine Alpcot Capital Management Ltd Altera Azteca Milling Ukraine LLC Alvis Realty Europe LLC American Councils for International Education: ACTR/ACCELS American Jewish Joint Distribution Committee Inc., Kiev Office American Machinery Company American Medical Centers Amplua Amstar Europe Amway Ukraine Ltd. ANCOR Personnel Ukraine LLC Antika Law Firm Apotex Inc. Representative Office in Ukraine ArcelorMittal Kriviy Rih, OJSC Argus Limited ARTA Investments ArtBuild Hotel Group Arzinger AstapovLawyers International Law Group Astelit LLC Asters ASTRA-KYIV LLC ATA LLC Atlantic Group AUCHAN Hypermarket Audit firm "RSM APiK" Austrian Airlines AUTO International Avellum Partners Avis Ukraine (CFI VIP-Rent) AVON COSMETICS UKRAINE Awara Group LLC AWT Bavaria AXA Insurance Axis Group Ltd. B.C. Toms & Co. BACARDI-MARTINI UKRAINE Baibarza & Partners Law Office Bain & Company Ukraine Baker & McKenzie - CIS, Limited Baker Tilly Ukraine (an Independent Member of Baker Tilly International) Baltic International Bank JSC Bathyscaphe LLC Bayer LTD BDO Legal Ukraine BDO LLC Beiersdorf Ukraine LLC BEITEN BURKHARDT BEKO Ukraine LLC Bel Shostka Ukraine/Bel Group, PJSC Benefit Systems LLC Benish GPS Ukraine Black Sea Investment Group Blitz-Inform, Private Joint Stock Company BMS Consulting Ltd Boston Consulting Group Ukraine LLC Brain Source International Brenntag Ukraine LLC British American Tobacco Ukraine / B.A.T. - Prylucky Tobacco Company BritMark Insurance Brokers Brown-Forman Ukraine LLC BUSIN Private Joint-Stock Insurance Company BUSINESS LINK Bytsko Travel Company Cadogan Ukraine Capital Times Investment Company Carbon Capital Services Limited Cargill AT, LLC Carlo Pazolini Carlsberg Ukraine CBRE Center for Business Skills Development (CBSD)/Thunderbird Russia Centre For Transport Strategies Ltd. CFC Consulting Chadbourne & Parke LLP Chartis Ukraine Сlosed Joint-Stock Insurance Company Chevron Ukraine LLC CHS Ukraine, LLC Cisco Systems Management B.V. in Ukraine CITA Travel Company Citibank, PJSC City State Clarus Eastern Europe ClearWater Ukraine Clifford Chance LLC CMS Cameron McKenna LLC CMS Reich-Rohrwig Hainz LLC Coca-Cola Beverages Ukraine Limited Coca-Cola Ukraine Limited Cogniance, Inc. Colgate-Palmolive Ukraine Comfort Properties Commercial Law Center, Charitable Organization Construction Machinery ContourGlobal Ukraine, Limited Liability Company Corstjens Ukraine CQGI Software LLC CRDF Global Credit Agricole Corporate and Investment Bank Creditwest Bank CRH-Podilsky Cement, JSC Cub Energy Inc D&Y, LTD Dalgakiran Compressor Ukraine Ltd. Danevych Law Firm DANONE LLC DataArt Solutions, Inc. Deane Group (Ukraine) The Deloitte & Touche USC, PJSC Delta Air Lines, Inc. Represented by AVIAREPS Group Delta Medical Delta Wilmar CIS DenzaWorkspace Derzhzovnishinform Deseret International Charities, Inc. Design Time Desnagrain Deutsche Bank DBU PJSC DHL DHL Logistics Ukraine Diana Lux Logistic Discovery Technology International, LLP DLA Piper Ukraine LLC Dogus Domar Travel Education DOOR Ukraine Doubinsky & Osharova Dow Europe GmbH Representative Office in Ukraine DPD Ukraine Dragon Capital DTEK DTEK Oil&Gas LLC DTZ DuPont Ukraine LLC Dyckerhoff Ukraine LLC E.I.Corporation E2Market EBRD - European Bank for Reconstruction and Development EBS EchoStar Ukraine LLC ECOMM Co. Edinburgh Business School Eastern Europe Representative Office Edvantis Software, Inc. Efes Ukraine Egorov Puginsky Afanasiev & Partners ELEKS Software Eli Lilly Vostok S.A. EMC Ukraine EMI UA ENERGOBANK, PJSC EngagePoint™ ENGARDE Attorneys at Law ENI UKRAINE LLC Ericsson Ukraine Ernst & Young LLC Erste Bank, PC eSoft Euro Leasing EuroCape New Energy EURODEAN INTERNATIONAL MOVERS Europ Insurance Brokers Evolution Media LLC Fairmont Grand Hotel Kyiv Fidem Life PJSC First Dnieper Investment Company First Realty Brokerage Ltd. Flextronics-Ukraine FM Logistic Dniepr, Subsidiary Company FM-Standard Focal Line Solar LLC Forum Bank, PJSC Forum Business City Forum Park Plaza Foyil Securities New Europe Frayman Holdings Limited Freescale Semiconductor Ukraine LLC Gala Media (Gala Radio, Gala TV, Gala Net) Galnaftogaz Concern PJSC GAP Ukraine LLC Gavilon Ukraine LLC GE Ukraine Gefco Ukraine GEMINI LLC Genom Biotech Gide Loyrette Nouel Global Restaurant Group - Ukraine LLC Golden Telecom Goodyear Dunlop Tires Ukraine Google LLC Grand Corporation Grischenko & Partners Law and Patent Offices Groupon UA Ltd Gryphon Investment Consulting Group LLC GSP Happy Farm Happy Vacations HayGroup Ukraine Health of Ukrainian People, International Charitable Foundation Healthyway Herbalife Ukraine Hewlett-Packard International Trade B.V. Representative Office in Ukraine HLB UKRAINE Holtec International - Ukraine Honda Ukraine LLC Honeywell Ukraine Horizon Capital HT Property West Hudson Global Resources Hyatt Regency Kyiv IBcontacts Ltd. IBM Ukraine iBPM LLC Ilyashev & Partners Law Firm Imperial Tailoring Company The Imperial Tobacco Ukraine IMS Global Limited INCI AKÜ Incom PJSC Indigo Insurance Company ALC Inflot Cruise&Ferry Ukraine Infocom JV Information Systems Security Partners (ISSP) ING Bank Ukraine INGO Ukraine, PJSIC Innovecs Innoware Ukraine Institute for Economic Research and Policy Consulting Intego Group, LLC INTEGRITES International Law Firm INTER TV-CHANNEL, PJSC Intercomp Global Services, Ukraine InterContinental Kyiv Interfax-Ukraine news agency International Business Centre (MDC LLC) International Finance Corporation International Management Institute (MIM-Kyiv) International Paper-Ukraine INTERPONT Ukraine Investment Capital Ukraine IREX - International Research and Exchanges Board ISA Prime Developments Iskander Energy Corporation ISS - Information Software Systems Ltd. ISTIL Group ISTIL Telecom / Xtra TV ITOCHU Corporation, Kiev Representative Office ITT Invest Jabil Circuit Ukraine Limited Jahn & Jensen Group Ukraine Jansen Capital Management Japan Tobacco International (JTI) John Deere Ukraina LLC Johnson&Johnson Ukraine Jones Lang LaSalle Kesarev Consulting Key Realty KievApartment.com d/b/a Save Travel Kievrianta Limited Liability Company Kimberly Clark Kinomania LLC KLS Ltd KM Core KM Partners Konnov & Sozanovsky attorneys-at-law Kornatskiys Private Farm Ltd. KPMG-Ukraine Ltd. Kraft Foods Ukraina Kuehne + Nagel Ukraine Kuwait Energy Ukraine Kyiv International School Kyiv Mohyla Business School Kyiv Post Kyiv School of Economics/Economics Education and Research Consortium, Inc (KSE/EERC) Kyiv-Atlantic Ukraine Kyivstar JSC Lactalis-Ukraine Lavrynovych and Partners Law Firm Law Firm "Vasko & Nazarchuk" Leater Legal Alliance Company LTD Leo Burnett Leroy Merlin Ukraine LG Electronics Ukraine Limelight Networks Ukraine LNK LLC Logos Translation Agency LOHIKA LTD, LLC Louis Dreyfus Commodities Ukraine Ltd Luhansk Taras Shevchenko National University Luxoft MacHOUSE Maersk Ukraine Malteurop Ukraine Manzaro Global Ventures Ltd. Mapia LLC Mars Ukraine Marti Ukraine LLC Mary Kay (Ukraine) Ltd., LLC MasterCard Europe Sprl Mazars Ukraine LLC MBS (Mega Business Software) McDonald`s Ukraine McKinsey and Company MEGABANK, PJSC METINVEST HOLDING LLC MetLife Alico METRO Cash & Carry Ukraine Ltd. Michelin Ukraine LLC Microsoft Ukraine, LLC Millennium Commercial Enterprises Ltd. (MCE) Mindspeed Technologies, Inc. Miratech MIROPLAST LLC. Mitsubishi Corporation Kiev Office Molson Coors Ukraine MoneyGram International Monsanto Ukraine, LTD Motorola Solutions Mriya Agroholding MSBUD Ltd MSD Ukraine LLC MTI MTS Ukraine Private Joint Stock Company Mykolaivcement OJSC, Lafarge Ukraine Myronivsky Hliboproduct NEO FORTE NEST "The real estate of capital" JSC Nestlé Ukraine LLC NetCracker NIBULON Ltd NIKO Group of Companies Nobel Ilac Sanayi ve Ticaret A.S. Noble Resources Ukraine Noblet Media CIS Noerr, TOV Nokia Siemens Networks Ukraine Norstone Financial Corporation NOVA Insurance Company JSC Nycomed: a Takeda Company Oakeshott Insurance Consultants Ltd OBI Ukraine Franchise Center Obriy Inc, JSC, American Express Representative Office Solutions Ukraine OK Internet Olytsky, Yatsenko and Partners Law Firm Open Borders Media Opera Hotel Optima-Leasing / Sixt Ukraine ORACLE Oranta, NJSIC Oriflame Cosmetics Ukraine, Subsidiary Company OSI Food Solutions Ukraine LLC OTP Bank JSC OTP Capital OTP Credit LLC Otten Consulting LLC Oxford Klass Pakharenko & Partners Palomar Systems Patern Ltd. PBN Company The PCF "Integro" Ltd Pechersk School International Kyiv PepsiCo Ukraine Perry Construction Peugeot Citroen Ukraine SARL Pfizer H.C.P. Corporation Philip Morris Ukraine PrJSC Philips Ukraine LLC Phoenix Center LLC Pioneer Hi-Bred Ukraine Piraeus Bank ICB Platinum Bank OJSC Pleon Talan PLS Logistics Services PMI Consult Eurasia Popko Brothers & Partners, Law Firm Porsche Leasing Ukraine LLC Portinvest LLC Pratt & Whitney - Paton PRAVEX-BANK, PJSCCB Premier International Premier Palace Hotel Printec Ukraine LLC ProCredit Bank PJSC Procter & Gamble Ukraine LLC Profi-Consulting AA Prominvestbank PJSC Propan-Trade PROVIDNA Insurance Company JSC PRP Ltd. PSB Films (Pack-Shot Boys Film) Publicis Visage Pulse Puma Ukraine PwC PZU Ukraine Insurance Company, PrJSC QBE Ukraine Quinn Properties Ukraine Raben Ukraine Radioaktive Film Radisson Blu Radisson Blu Hotel, Kyiv Podil Raiffeisen Aval Asset Management LLC Raiffeisen Bank Aval, PJSC Ramada Encore Kiev Raytheon Technical Services Company, LLC ReckittBenckiser Household & Healthcare Ukraine Regus LLC Reikartz Hotels & Resorts Representative Office ExxonMobil Exploration and Production Ukraine B. V. Representative office of NCH Advisors Inc. in Ukraine RGData LLC Risk Advisory Group plc, The Riviera Boutique Hotel Rokada LLC Royal Catering Services, RCS RULG - Ukrainian Legal Group RUSSIA Fachspedition Dr. Lassmann G.m.b.H RWE Dea Ukraine LLC S Pharma LLC Saint-Gobain Group SALANS Salkom Law Firm Samsung Electronics Ukraine Company, LLC Sandoz Pharmaceutical Sanofi-Aventis Ukraine LLC Sayenko Kharenko SC Johnson Scan-Shipping LLC Scania Ukraine LLC Schneider Electric Ukraina Schoenherr Ukraine LLC, Attorneys at Law Science and Technology Center in Ukraine Scientific-Technical Center of Subsurface Investigation SEB CORPORATE BANK PJSC Senator Apartments Service-Agrocenter LTD Seven Hills Shell SICH SECURITY SERVICES Siemens Ukraine SigmaBleyzer SimCorp Ukraine LLC SINIAT, Additional Liability Company SITRONICS IT Sky Travel HRG Ukraine SkyNet Worldwide Express SMART business SME Capital Softjourn, Inc. SoftServe, Inc. Sokolovskyi and Partners Law Firm SOS Children's Villages, Charitable Fund, International Charitable Organization SPN Ogilvy Sportmaster Ukraine Squire Sanders Ukraine Staff Service Ukraine Stanfy Sumitec Ukraine Sumitomo Corporation Central Eurasia LLC, Kyiv Representative Office Sumix Ukraine Summit Motors Ukraine SUN InBev Ukraine, PJSC Suntrade S.E. / Bunge Ukraine SvitSoft LTD Swedbank JSC Swissport Ukraine LLC Syngenta SysIQ Inc./ SysIQ UA System Capital Management (SCM) TABASCO TASK LTD TEAM International Services, Inc. Tebodin Ukraine CFI TEN Group LLC Tetra Pak Ukraine, SE The Chamber The Giles Legal Practice TMF Ukraine LLC TNK-Ukraine, EFI Torrent Pharmaceuticals Ltd Toyota-Ukraine TPM International, Inc. Trade House International Trade Service LTD Transinvestservice Transnational Education Group Tranzcapital Travel Centre TRIME Travelport Trelad International Real Estate Agency Triada UCRAFARMA S.A. UkrAgroConsult UKRAINE CONSULTING Ukraine International Airlines (UIA) Ukrainian Marketing Group® Ukrainian National Lottery Ukrainian Processing Center, PJSC Ukrainian-American Liberal Arts Institute "Wisconsin International University (USA) Ukraine" UkrFinance Ukrproduct Group Limited UkrSibbank, JSC UKRSOTSBANK, PJSC Ultratest Systems Ltd. Ulysses UniCredit Bank, PJSC Unilever Ukraine LLC UNIQA Insurance Company, PrJSC Universal Bank UPS USAID - East Europe Foundation USAID - Ohio State University Parliamentary Development Project II USAID - Public Private Partnership Development Program (P3DP) USAID - Ukraine National Initiatives to Enhance Reforms - PACT USAID AgroInvest Project in Ukraine - Chemonics International Inc. USAID FAIR Justice Project USAID Financial Sector Development Project, implemented by Booz Allen Hamilton USPOT Ltd Uvecon Consulting Company LLC UVK V.I.Tech-Plus Vanco Prykerchenska Ltd Vashchenko, Bugay and Partners Vasil Kisil & Partners Viewdle Inc. Vikoil Ltd Visa Ukraine LLC VISION TV Viterra Ukraine LLC Volvo Ukraine LLC Vseswit ltd., Asset Management Company Ward Howell WEATHERFORD UKRAINE WellTravel Western Union Financial Services GmbH, Representative office in Kiev Westinghouse Electric (Asia) S.A. Whirlpool Europe s.r.l. Willard Willis Insurance Brokers Limited Winner Automotive, LLC Winner Imports Ukraine Wizz Air Ukraine Airlines LLC WorldAPP, Inc. WorleyParsons Europe Limited WRIGLEY Ukraine, LLC X.COMMERCE DEVELOPMENT CENTER LLC Xerox Ukraine Ltd. Yug Contract Co., Ltd. Zelmer Ukraine Zeppelin Ukraine LLC, LLC with Foreign Investments Zest Outsourcing Zinteco
Attache for Economic and Commercial Affairs of the Republic of Peru in Ukraine Chancellery of the Apostolic Nunciature Consulate of Ukraine in the US Delegation of the European Union to Ukraine Embassy of Austria Embassy of Belarus Embassy of Canada Embassy of Finland Embassy of Georgia to Ukraine Embassy of Japan Embassy of Malaysia Embassy of Palestine Embassy of Republic of Argentina Embassy of Romania Embassy of Switzerland Embassy of the Arab Republic of Egypt Embassy of the Czech Republic Embassy of the Federal Republic of Germany Embassy of the Federative Republic of Brazil Embassy of the French Republic Embassy of the Hellenic Republic Embassy of the Islamic Republic of Pakistan Embassy of the Italian Republic Embassy of the Kingdom of Morocco Embassy of the Kingdom of Norway Embassy of the Kingdom of Saudi Arabia Embassy of the Kingdom of Spain Embassy of the Kingdom of Sweden Embassy of the Kingdom of the Netherlands Embassy of the People's Republic of China Embassy of the Portuguese Republic Embassy of the Republic of Bulgaria Embassy of the Republic of Croatia Embassy of the Republic of Estonia Embassy of the Republic of Hungary Embassy of the Republic of India Embassy of the Republic of Indonesia Embassy of the Republic of Iraq Embassy of the Republic of Korea Embassy of the Republic of Latvia Embassy of the Republic of Lithuania Embassy of the Republic of Macedonia Embassy of the Republic of Moldova Embassy of the Republic of Poland Embassy of the Republic of Slovenia Embassy of the Republic of South Africa Embassy of the Republic of Turkey Embassy of the Republic of Uzbekistan Embassy of the Russian Federation in Ukraine Embassy of the Slovak Republic Embassy of the Socialist Republic of Vietnam in Ukraine Embassy of the State of Israel Embassy of the State of Kuwait in Ukraine Embassy of the United Kingdom of Great Britain and Northern Ireland Embassy of the United Mexican States Embassy of the United States of America Embassy of Ukraine in the United Kingdom of Great Britain and Northern Ireland Embassy of Ukraine in the United States of America Honorary Consulate of Bosnia and Herzegovina in Ukraine Honorary Consulate of Ireland Honorary Consulate of the Grand Dutch of Luxemburg Honorary Consulate of the Republic Iceland Honorary Consulate of the Republic of Chile Honorary Consulate of the Republic of Cyprus in Kyiv Honorary Consulate of the Republic of Peru Honorary Consulate of the Republic of the Philippines International Monetary Fund Olimpiyskiy National Sports Complex Organization for Security and Co-operation in Europe Royal Danish Embassy in Kyiv Royal Embassy of Belgium U.S. Agency for International Development (USAID) United Nations Development Programme United Nations Office in Ukraine World Bank Office in Ukraine Chamber Membership Card Information
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No. of children
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Children Birthday
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Children Birthday
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How Frequently, during a year, do you fly
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I, abovementioned, hereby give my unequivocal and voluntary consent to the American Chamber of Commerce in Ukraine ("Chamber ") for processing my personal data* in the database of personal data "Database of employees of Members of the American Chamber of Commerce in Ukraine" understanding the Chamber is a non-governmental organization that focuses on providing employees of the Membership with: business networking activities, facilitating the obtainment of visas to the USA, facilitating participation of Members of the American Chamber of Commerce in Ukraine in the MAXI Loyalty Program, provided by "Benefit Systems LLC." / Я, вищезазначений / вищезазначена, даю однозначну і добровільну згоду Американській Торгівельній Палаті в Україні ("Компанія ") на обробку моїх персональних даниx* у базі персональних даних під назвою "База співробітників компаній-членів Американської Торгівельної Палати в Україні" з метою виконання Компанією своєї функції громадської організації, забезпечення реалізації відносин у сфері громадської діяльності, сприяння отриманню віз в США, сприяння участі членів Американської Торгівельно Палати в Україні в програмі лояльності MAXI, що здійснюється ТОВ "Бенефіт Сістемс".
I also agree that the duration of processing my personal data by the Chamber will not exceed 10 years. / Я також погоджуюся, що строк обробки Компанією моїх персональних даних становитиме не більше 10 років.
*I also agree that my personal data that will be processed by the Chamber and will be limited to the following personal data/ Я також згоден/згодна на те, що мої персональні дані, які оброблятимуться Компанією, будуть обмежені такими моїми персональними даними:
First, Middle and Last Name / ПІБ
Date of Birth / Дата народження
Home address / Домашня адреса
Work address / Робоча адреса
Marital status and number of children / Родинний стан та кількість дітей
Gender / Стать
Profession and occupation / Спеціальність
Position / Посада
Employer / Працевлаштування
Telephone / Телефон
Email / Електронна пошта
Citizenship / Громадянство
Data of foreign passport / Дані закордонного паспорта
Information about previous visas to the USA / Наявність попередніх віз у США
I hereby give my unequivocal and voluntary consent to the Chamber for transmitting my aforesaid personal data to "Benefit Systems LLC" with a view to participating in MAXI Loyalty Program; to the Embassy of the United States of America to Ukraine in case of need to apply for a U.S. business visa. I agree that the Chamber is not obliged to notify me about transmitting my personal data to the aforesaid organizations with the aforesaid purpose. / Цим я також надаю свою безумовну та однозначну згоду Компанії на передачу моїх персональних даних у вищезазначеному обсязі до ТОВ "Бенефіт Сістемс" з метою участі у програмі лояльності MAXI; Посольству США в Україні в разі необхідності отримання бізнес-візи до США. Я погоджуюсь з тим, що Компанія не зобов'язана повідомляти мене про передачу моїх персональних даних до вищезазначених осіб з вищезазначеною метою.