Appendix No. 6 to Art. 47, para. 1, item 8 and art. 52, para. 2 and 4 of the PPE
STANDARD FORM FOR EXERCISE RIGHT OF WITHDRAWAL
To ...........................
/merchant name/
................................................ ..............................
/address, EIC/
I hereby give notice that I am withdrawing from my contract for the purchase of the following goods/services:
................................................ ........ /product description/
The goods were ordered on ...................
The goods were received on ...................... /indicate the date of receipt by the user/
................................................ ................................../Username/
City/Street ................................................... ........................ /Address of the user/
....................... ............................
/Date/ /User Signature/
The user has the right within 14 days to unconditionally withdraw from a distance contract or an off-premises
contract without paying any costs, except for those of delivery in the event that he has chosen a different
from the standard cheapest for the trader, the method of delivery of the order, as well as the costs of
returning the goods back.
The 14-day period begins on the date of:
conclusion of the contract - in the case of a service contract;
acceptance of the goods by the consumer or by a third party other than the carrier
Within 14 days after the stated desire to withdraw from the contract, the consumer must return the goods to
the trader. Within 14 days from the date on which he was notified of the user's decision to withdraw from the
contract, the trader shall refund all sums received from the user, including delivery costs.