Sample withdrawal form


(If you want to revoke the contract, please fill out this form and send it back.)

- To asdec life GmbH, Zur Königsbrücke 16, 49549 Ladbergen, fax number: 05485-831491, e-mail address: info@asdec-life.de:

- I/ we (*) hereby revoke the contract concluded by me/ us (*) for the purchase of the following goods (*)/
the provision of the following service (*)

- Ordered on (*)/ received on (*)

- Name of consumer(s)
- Address of the consumer(s)
- Signature of the consumer(s) (only if notification is made on paper)
- Date

(*) Delete where not applicable.