Withdrawal form

(*) Delete where not applicable.
Annex 2
Books VI and XIV of the Code of Economic Law
MODEL WITHDRAWAL FORM
(Please complete and return this form only if you wish to withdraw from the contract)
– To the attention of
[the company or the person exercising a liberal profession inserts here its name, its geographical address and,
when available, their fax number and e-mail address]
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— I/We (*) hereby notify you of my/our (*) withdrawal from the contract relating to
the sale of goods (*)/for the provision of services (*) below
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— Ordered on (*)/received on (*)…………………………………………………………………………………………………… ……….
— Name of consumer(s) ………………………………………………………………………………………………………
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— Address of the consumer(s) …………………………………………………………………………………………………
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– Date …………………………………………………………………………………………………
— Signature of consumer(s)
(only in case of notification of this form on paper)
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