Cancellation Form

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

To: FERJA
Eikenhof 7
5243 RJ Rosmalen
The Netherlands

I / We * hereby inform you that I / we * are withdrawing our agreement
on the sale of the following products: [product description] *
the delivery of the following digital content: [indication of digital content] *
the provision of the following service: [designation of service] *,
recall / recall *

Ordered on * / received on * [order date with services or receipt with products]

[Name of consumers (s)]

[Consumer address (s)]

[Signature consumer (s)] (only when this form is submitted on paper)

* Delete what does not apply or enter what applies.