## Model withdrawal form

> Placeholder: This form will be replaced by a translation of the legally binding German model withdrawal form before publication.

(Complete and return this form only if you wish to withdraw from the contract.)

To: [name, address and email address of the provider]

I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract for the provision of the following service (*):

- Ordered on (*) / received on (*):
- Name of consumer(s):
- Address of consumer(s):
- Signature of consumer(s) (only if this form is notified on paper):
- Date:

(*) Delete as appropriate.