Sample withdrawal form – FlexCom Communications Ltd.

Withdrawal Statement*

Recipient: FlexCom Kommunikációs Kft (address: 2151 Fót, Móricz Zsigmond út 45., e-mail: info@tracking.hu)

I, the undersigned, hereby declare that I exercise my right of withdrawal/termination with regard to the contract for the purchase of the following goods or the provision of the following service:

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Date of contract conclusion / date of receipt: ......................................................................................................................

Name of consumer: ...................................................................................................................................................................

Address of consumer: ...................................................................................................................................................................

I request that the purchase price be refunded to the following bank account number (fill in only if you wish the refund to be made by bank transfer):

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Signature of consumer: (only if the statement is made on paper)

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Date: ............................................................................

*Prepared on the basis of the model statement in Annex 2 of Government Decree 45/2014. (II.26.).