Statement on the return of the goods:

 

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First name and last name

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Address:

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Contact tel.

 

 

Statement of withdrawal from a distance contract

 I certify that the Article. 27 of the Act of 30 May 2014 on the Rights of addressing consumer goods purchased in the form of:

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 Goods received the day: .................................

 The account number to which my return, please make provision

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 I declare that the returned merchandise is intact and has not been used.