FORM OF WITHDRAWAL

(This form should be completed and returned just in case you wish to withdraw from the contract)

- Recipient: Zakład Elektroniczny „TATAREK” Jerzy Tatarek ul. Świeradowska 75 50-559 Wrocław, e-mail: sklep@sklep.tatarek.com.pl

- I / We (*) hereby give notice / announce (*) on my / our withdrawal from the sales contract of the following things (*) , contract for the supply of the following items (*) ,contract for work consisting in the execution of following things (*) / provision of the following services (*)

- Date of the agreement (*) / receipt (*)

- First Name and Last Name of customer (s)

- Address of customer (s)

- Signature of customer (s) (only if the form is sent on paper)

- Date

(*) Delete as appropriate.