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Template: Withdrawal of a remote purchase (over the Internet, by mail order, teleshopping or telephone)

Attention: ................................................ [the trader shall enter his name, geographical address and, where available, fax number and e-mail address]  ::

I/we (*) hereby notify you/us (*) of my/our (*) withdrawal from the contract for the sale of the property (*)/for the provision of services (*) below:

Ordered on (*)/received on (*):

Name of consumer(s):

Address of consumer(s):

Signature of the consumer(s) (only if this form is notified on paper):

Date:

(*) Strike out what does not apply.

Verified 04 December 2018 - Directorate for Legal and Administrative Information (Prime Minister)

For details, please use the practical information sheets :