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SEPARATE STANDARD WITHDRAWAL FORM TO FACILITATE THE RIGHT OF WITHDRAWAL

Right of withdrawal The consumer has the right to withdraw from this contract within 14 calendar days without giving any reason. The right of withdrawal starts from … (to be filled in by the trader before providing the form to the consumer). Where the consumer has not received this form, the withdrawal period starts when the consumer has received this form, but expires in any case after one year and 14 calendar days. Where the consumer has not received all the required information, the withdrawal period starts when the consumer has received that information, but expires in any case after three months and 14 calendar days. To exercise the right of withdrawal, the consumer shall notify the trader using the name and address indicated below by using a durable medium (e.g. written letter sent by post, e-mail). The consumer may use this form, but it is not obligatory. Where the consumer exercises the right of withdrawal, the consumer shall not be liable for any costs. In addition to the right of withdrawal, national contract law rules may provide for consumer rights, e.g. to terminate the contract in case of omission of information. Ban on advance payment During the withdrawal period any advance payment by the consumer is prohibited. The prohibition concerns any consideration, including payment, provision of guarantees, reservation of money on accounts, explicit acknowledgement of debt, etc. It includes not only payment to the trader, but also to third parties. Notice of withdrawal To (Name and address of the trader) (*): I/We (**) hereby give notice that I/We (**) withdraw from the contract, Date of conclusion of contract (*): Name(s) of consumer(s) (***): Address(es) of consumer(s) (***): Signature(s) of consumer(s) (only if this form is notified on paper) (***): Date (***): (*) To be filled in by the trader before providing the form to the consumer. (**) Delete as appropriate. (***) To be filled in by the consumer(s) where this form is used to withdraw from the contract. Acknowledgement of receipt of information: Signature of the consumer: