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

- Recipient: TATAREK Ltd. ul. 艢wieradowska 75 50-559 Wroc艂aw, e-mail:

- 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.