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Withdrawal Form

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

- On
Scheepswerf 1
1271GB Huizen

- I / We (*) part / parts (*) hereby give notice that I / We (*) our agreement relating to the sale of the following goods / provision of the following service (*) withdraw from my / (*):

- Ordered on (DD-MM-YYYY): - Order number:

- Receive (DD-MM-YYYY):

- Name / s consumer (s)

- Address of consumer (s):

- IBAN Account number:

- Signature of consumer (s) (only if this form is notified in writing)

- Date (DD-MM-YYYY):

(*) Delete if not applicable.