Model form of withdrawal

A model of withdrawal form

(ANNEX NUMBER 2 TO ACT ON CONSUMER RIGHTS)

(This form must be filled out and sent back only in case you wish to withdraw from the contract)

– Addressee :

e:Exq MARTA KONIARSKA

ul. Lipowa 2B/16,

81-572 Gdynia (Poland)

4zieloneslonie.pl
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– I / We (*) hereby announce (*) of my/our withdrawal from the purchase agreement of the following things (*) contract for the supply of the following items (*) contract for work consisting of performing the following things (*) /provision of the following services (*)

– The date of conclusion of the contract (*)/receipt(*)

– Name and surname of the consumer(s)

– Address of the consumer(s)

– Signature of the consumer(s) (only if the form is sent on paper)

– Date

(*) Delete as applicable.