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V VENGEANCE

Specimen Revocation Form

Legal

Template for consumers wishing to declare a withdrawal.

Form

If you wish to revoke the contract, please fill up this form and send it back to us.

To Quang Hai Pham, Lessingstraße 10, 10555 Berlin, Email address: contact@vvengeance.berlin:

I/we (*) herewith revoke the contract concluded by me/ us (*) regarding the purchase of the following products (*)/ the provision of the following service (*)

Ordered on (*)/ received on (*)

Name of the consumer(s)

Address of the consumer(s)

Signature of the consumer(s) (only in case of a notification on paper)

Date

(*) Cross out the incorrect option.

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