Your name

Email Address (please use business address)

Productname (or phantasy name), just type X when confidential

Language of consumers Language of consumers English French German Dutch Other

Word text available yet? Word text available yet? Yes No

Mock-up for testing purposes by KHN ? Mock-up for testing purposes by KHN ? Yes No, use ours

Timing Timing q1 2022q2 2022q3 2022q4 2022q1 2023

RUT service RUT service Full test Focus 4-6 questions (parent RUT by KHN) Bridge (parent RUT by KHN)

Message

With my submission I give permission to process my data, in the way described in KHN's Privacy statement With my submission I give permission to process my data, in the way described in KHN's Privacy statement Agree

Would you like us to review your text ? Would you like us to review your text ? Yes, we have room for amendments No, test as it is