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Attachment no. 1.
Template of a statement on withdrawal from the agreement
TEMPLATE OF A STATEMENT ON WITHDRAWAL FROM THE AGREEMENT
(this form should be filled out and sent back only if you wish to withdraw from the contract)
• Addres [here the trader’s name, full postal address and e-mail address]:
• I/We() hereby inform() about my/our() withdrawal from the contract of sale of the following goods()/provision of the following service() • Date of order()/collection(*):
• Name(s)/name(s) of the consumer(s):
• Address of the consumer(s):
• Signature of the consumer(s) (only if the form is sent on paper):
• Date:
(*) Delete what doesn’t apply.