MODEL WITHDRAWAL FORM — NINETTA9
Complete and return this form only if you wish to withdraw from the contract.
You may also send another unequivocal statement.

To: Ninetta9, Cornelis van der Lijnstraat 1, 2593 NG Den Haag
Email: ninetta9customs@hotmail.com

I/We (*) hereby give notice that I/we (*) withdraw from my/our (*) contract for
the sale of the following goods (*) / provision of the following service (*):

..........................................................................
Ordered on (*) / received on (*): ........................................
Name(s) of consumer(s): ...................................................
Address of consumer(s): ...................................................
..........................................................................
Signature of consumer(s) (only if submitted on paper):
..........................................................................
Date: ....................................................................
(*) Delete as appropriate.

Optional order number: ....................................................
Return address: Cornelis van der Lijnstraat 1, 2593 NG Den Haag.