Complete and return this form only if you wish to withdraw from the contract.

I/We hereby give notice that I/we withdraw from my/our contract of sale of the following goods / for the supply of the following service:

______________________________________________________________

Ordered on / received on:

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Name of consumer(s):

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Address of consumer(s):

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Signature of consumer(s) (only if this form is notified on paper):

______________________________________________________________

Date:

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Source: Annex I, Part B of Directive 2011/83/EU of the European Parliament and of the Council on consumer rights.

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