Sample declaration for withdrawal

Recipient: Tóbelurna Ltd.

(address: 1026 Budapest, Szilágyi Erzsébet fasor 97. 1., e-mail: info@tobelurna.hu)

I/We, the undersigned, declare that I/we exercise my/our right of withdrawal/cancellation in respect of the contract for the purchase of the following product(s) or the provision of the following service(s):

………………………………………………………………………………………………………………………………………………………………………………

Date of conclusion of contract / date of receipt: …………………………………………………………

Name of the consumer(s): …………………………………………………………………………………

Address of the consumer(s): …………………………………………………………………………………

The purchase price should be returned to the following bank account number (please fill in if you would like the purchase price to be returned by bank transfer):………………………………………………………………………………………………………………………………………………………

Signature of the consumer(s): (for paper declarations only)

…………………………………………………………………………………

Date: