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.


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