Sample Withdrawal Form

Annex No. 1 – Model Withdrawal Form

Addressee: Jan Zítko Skuteckého 1383/8 163 00 Prague - Řepy email: info@treziqo.com

I hereby give notice that I withdraw from the agreement for the provision of the service / subscription:

Service name: Treziqo Date of conclusion of the agreement / order: __________ Consumer’s full name: __________ Consumer’s address: __________ Email used during registration: __________ Date: __________ Consumer’s signature (only if this form is submitted in paper form): __________