Cancellation form

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(CONSUMER PROTECTION ACT, S. 190)

 

To: ................................................

(name of merchant)

....................................................

 

....................................................

(address of merchant)

Date: ...............................................

(date of sending of this form)

 

By virtue of section 193 of the Consumer Protection Act, I cancel the contract (No . ..)

(number of the contract if indicated)

made ...........at ...................................

(date when the contract was made)(place where the contract was made)

.......................................

(name of consumer)

.......................................

(signature of consumer)

.......................................

 

.......................................

(address of consumer)

 

Note: For proper procession of your cancellation: we also need your registered e-mail address with CDating and your user name (or alternatively, the code assigned to you)

 

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