WITHDRAWAL FORM

(fill out and send this form only if you wish to withdraw from a contract concluded remotely)

LYRA GROUP s.r.o.

Pri parku 1

951 12 Ivanka pri Nitre,

E-mail: ..........@..........

Phone: +421 ........

Notice of Withdrawal from the Contract

I hereby notify you that I am withdrawing from the contract for the supply or provision of this product:

Date of order/date of receipt*: ___________________________________________________

Order number: _________________________________________________________________

Name and surname of the consumer(s): __________________________________________

Address of the consumer(s): ____________________________________________________

Signature of the consumer(s)*: ____________________________________________________

(only if this form is submitted in paper form)

Date ____________

• Cross out what does not apply.