Notice of withdrawal

(sample)

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

To: HYD Rákkutató és Gyógyszerfejlesztő Korlátolt Felelősségű Társaság, 1119 Budapest, Fehérvári út 79., Hungary, info@preventa.hu

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

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

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