Withdrawal statement form

SAMPLE STATEMENT ON WITHDRAWAL FROM THE CONTRACT (to be filled in and sent back only if you wish to withdraw from the contract)

 

- Addressee [here the consumer should enter the name of the trader, full address as well as fax number and email address (if available)] – I/We* hereby inform about my/our withdrawal from the sales contract covering the following items(*) / delivery contract covering the following items(*) / project contract covering the following items(*) / covering the provision of the following services (*) – Date of the contract (*) / delivery (*) – Full name of the consumer(s) – Address of the consumer(s) – Signature of the consumer(s) (only if the form is to be sent as a hard copy) – Date (*)

Delete as appropriate.