CONTRACT WITHDRAWAL FORM
Fill in and send this form if you wish to withdraw from the purchase contract to the seller:
program health as, Drobného 27, 841 01 Bratislava
ID number:
I hereby withdraw from the purchase contract for the goods:
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Order number:
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Date of receipt of goods:
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Name and surname of the consumer:
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Address of the consumer:
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Account to which the refund should be made:
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IBAN:
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Consumer's signature:
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A date:
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The place:
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