MODEL WITHDRAWAL NOTICE
Use only where the withdrawal right applies to the relevant contract.

To: Amelia Anna Wozniak EI
21 rue de Lens, 59000 Lille, France
wozniakamelia@inbox.eu

I notify my withdrawal from this contract: [service and reference]
Contract concluded on: [date]
Consumer name: [name]
Consumer address: [address]
Date: [date]
Signature: [paper notices only]