Appendix 1: Sample Withdrawal Form

(Please complete and return this form only if you wish to withdraw from the contract)

To the attention of:

The company

whose registered office is located at 125 boulevard Jean Jaurès, 92100 Boulogne-Billancourt,‍

I hereby notify you of my withdrawal from the contract concerning the provision of services below:

Subscribed on ()/received on ():

Consumer's Name:

Consumer's Address:

Consumer's Signature (only if this form is notified on paper):

Date:

(*) Strike out the unnecessary mention.