Terms and Conditions

Date of the last update of the Policy: 15/01/2024

1. COUNTRIES NOT SUPPORTED

1.1. According to international sanctions and our internal risk policy we reserve rights to reject any business relations with customers from following countries listed below:

Afghanistan
Bahamas
Belarus
Bosnia and Herzegovina
Botswana
Burkina Faso
Cayman Islands
Cuba
Eritrea
Ethiopia
French Guiana
Ghana
Guyana
Iran
Iraq
Islamic Republic of Lebanon
Lao People's Democratic Republic
Libyan Arab Jamahiriya
Morocco
Myanmar
North Korea
Pakistan
Palestinian Territory Occupied
Russia
Sao Tome and Principe
Senegal
Somalia
Sri Lanka
Sudan
Syrian Arab Republic
Trinidad and Tobago
Tunisia
Uganda
Vanuatu
Yemen

(“Restricted countries”)


2. DEFINITIONS

2.1. Account means the Website’s user interface allowing you to save a Gift Me Crypto Voucher, to obtain information related to a Gift Me Crypto Voucher, and to use the Services. At the same time, an Account is a virtual personal profile of the Consumer allowing access to the functions of the Website and its individual functions and services.

2.2. Agreement means the agreement between the Provider and the Consumer concluded in the electronic form by means of Order, which is made out of these GTCs, Privacy Policy and all related legal documents, information and instructions for the use of the Website and the Services, which form integral parts of this Agreement.

2.3. AML Law means the Slovak Act No. 297/2008 Coll. Act on protection against money laundering and terrorist financing and on the amendment to certain acts (“AML Act”) and any other applicable laws pertaining to money laundering, terrorism financing, bribery, corruption, tax evasion, fraud etc.

2.4. Consumer means a natural person who, when entering into and performing the Agreement, does not act within the scope of his/her business, employment or occupation. The Consumer is a Party.

2.5. Conversion service or Conversion means a service provided by Provider consisting of conversion of FIAT currency into Cryptocurrency by means of Gift Me Crypto Vouchers, conversion between Cryptocurrencies and conversion of Cryptocurrency into FIAT currency.

2.6. Gift Me Crypto Voucher means a digital voucher that can be purchased for FIAT currency and exchanged for a designated Cryptocurrency offered on the Website; Gift Me Crypto Voucher is not a means of payment, an electronic money means or any other means pursuant to the applicable payment services laws.

2.7. Cryptocurrency means a digital currency in which encryption techniques are used to regulate the generation of units of currency and verify the transfer of funds, operating independently of a central bank.

2.8. Custody services mean custody services of Cryptocurrencies belonging to Consumer provided by Fintegence.

2.9. Distributor means a registered person who successfully created an account and provides Consumers with other methods of payments, as it is described in Article 7 of these GTCs.

2.10. Fees means all fees imposed by Provider for the provision of the Services.

2.11. FIAT currency means government-issued currency.

2.12. Fintegence means Fintegence, s.r.o., with its registered office at Bottova 2/A, Bratislava 811 09, Identification No.: 47 956 925, registered in the Commercial Register of the District Court Bratislava III, section: Sro, insert No.: 171365/B, VAT number: SK2024158059.

2.13. Moderator means a person in an employment or other similar relationship with the Provider, who performs actions aimed at resolving any issues that may arise between the Distributor and the Consumer.

2.14. Nominal Value means the nominal value of a Gift Me Crypto Voucher as determined by the Consumer in the Order. At the same time, the Nominal Value serves as the nominal value that forms the basis of the Conversion into the Cryptocurrency selected by the Consumer when redeeming the Gift Me Crypto Voucher.

2.15. Order means a Consumer's instruction to buy Gift Me Crypto Voucher placed through Website, where the Nominal Value of the Gift Me Crypto Voucher, designated Cryptocurrency for which the Gift Me Crypto Voucher is to be subsequently exchanged and the payment method is stated.

2.16. Partner means a business partner of the Provider included in the affiliate partner program who provides the Gift Me Crypto Voucher to Consumers.
2.17. Party means the Provider and the Consumer who have entered into the Agreement with each other.

2.18. Provider means Fintegence. Contact details [email protected], telephone: 0048791 024 057, available Monday to Friday from 9.00 a.m. until 5.00 p.m. (Central European Time).

2.19. Services mean Conversion services and Custody services.

2.20. Wallet means a digital wallet provided by Fintegence for storing of Consumer’s Cryptocurrency.

2.21. Website means the website https://giftmecrypto.io.


3. INTRODUCTORY PROVISIONS


3.1 These General Terms and Conditions (the “GTCs”) are issued by Fintegence.

3.2. Fintegence is the holder of relevant authorization for the provision of virtual currency wallet and virtual currency exchange as defined in the AML Act. Please note that the National Bank of Slovakia does not currently supervise the provision of services related to virtual currency.

3.3. These GTCs set out the terms and conditions that apply to your use of:

3.3.1 the Website;
3.3.2. the Account;
3.3.3. Conversion services, including purchase of the Cryptocurrency by means of a Gift Me Crypto Voucher,
3.3.4. Custody services.


As a Consumer, you accept and agree to these GTCs and the Privacy Policy published on the Website valid at the time of opening the Account by clicking on “I agree” in the process of Account registration. If you do not agree with these GTCs and the Privacy Policy, you shall not use the Website, access your Account and use the Services.

3.5. Any legal relationships not explicitly provided for by these GTCs will be governed by the applicable laws of the Slovak Republic, unless stipulated otherwise.


4. ACCOUNT REGISTRATION

4.1. Each Consumer must open an Account before using Services. When you register the Account, you must provide your valid email address, which shall be confirmed by you in order to complete the Account registration. The Provider may refuse, in its discretion, to open the Account for you. The Consumer agrees to provide complete and accurate information when opening the Account, and agrees to timely update any information provided to Provider. 4.2. By registering to use the Account, you represent and warrant that:

4.2.1 as an individual, you are at least 18 years of age; 4.2.2. you are not resident, located in or otherwise attempting to access the Website or use Services from Restricted countries; 4.2.3. the purpose and intended nature of transactions carried out on the Website is trading. 4.2.4. you are not a politically exposed person who is exposed to particular risks because of the (political, judicial or administrative) prominent public functions you hold or have held; 4.2.5. funds or property used in this business relationship is your property; 4.2.6. you act in your own name and not as agent of any third party when using Services.


5. CUSTOMER IDENTIFICATION AND VERIFICATION

5.1. The Provider is an obliged person pursuant to Article 5 par. 1, letter o) and p) of AML Act. In this respect, prior to provision of Services, the Provider is, inter alia, obliged to request your personal identification data and to verify your identity as it is necessary to verify your identity to prevent money laundering and terrorist financing. In this regard, the Provider is authorized to request from you supporting information and documents such as a copy of the identity documents, confirmation of permanent residence, proof of address, information concerning the origin of funds etc. In order to verify your identity the Provider may, for the purposes of validating your identity and in order to fulfil any obligations that may arise from application of AML Laws, use third-party solutions, including software solutions using biometric identification or artificial intelligence.

5.2. Verification of the Consumer’s identity is performed through automated software solution provided by UAB “iDenfy, operated via the website https://www.idenfy.com/. As the processor, the UAB “iDenfy” has implemented numerous technical and organizational measures to ensure the most complete protection of personal data processed through this website, and the relevant privacy policy is published in the aforementiond websited https://www.idenfy.com/privacy-policy/.

5.3. The Provider reserves the right to withhold or cancel the transaction with the funds intended for the purchase of the Gift Me Crypto Voucher until the statutory conditions resulting from the relevant AML Laws have been fully satisfied.


6. ORDER AND REDEMPTION OF GIFT ME CRYPTO VOUCHERS

6.1. The Agreement is entered into by means of an Order and is validly concluded at the moment the Order is placed by Consumer.

6.2. By entering into the Agreement, these GTCs form an integral part of Agreement and are binding on the Parties in their entirety.

6.3. The Agreement may also be entered into through our Partners, within their transactions. 6.4. If your identity has been verified successfully in accordance with Article 5 of these GTCs, you will be redirected to the payment service provider’s website that will execute the payment method of your choice.

6.5. If the Nominal Value of the Gift Me Crypto Voucher has been paid successfully, you will acquired the Gift Me Crypto Voucher and you therefore have the right to execute the Conversion by means of an “authorisation code” you enter in the location specified on the Website. Then you will be notified of the amount of the Cryptocurrency if you decide to redeem the Gift Me Crypto Voucher. Conversion may only be executed in respect of the full Nominal Value; no Conversions of a part of the Nominal Value are permitted.

6.6. The Agreement shall became effective upon successful payment of the Nominal Value pursuant to clause 6.5 of GTCs.

6.7. Upon successful payment of the Nominal Value, you will receive the confirmation with payment summary and three options you must choose from:

6.7.1. to get Cryptocurrency to Wallet by instant exchange of Gift Me Crypto Voucher;
6.7.2. to get Gift Me Crypto Voucher, which can be exchanged for a designated Cryptocurrency within period specified in clause 6.9 of these GTCs; and
6.7.3. to transfer Cryptocurrency of your choice to any third party by using its phone number or e-mail.


6.8. When redeeming the Gift Me Crypto Voucher in the form of a Conversion request, please note that this request is valid for no more than 15 (in words: fifteen) seconds from its creation. Thereafter, the Conversion request may change due to a change in the conversion rate that took place between the time the request was made and its expiration pursuant to this sentence.

6.9. Please note that the validity of the Gift Me Crypto Voucher is limited to 180 (in words: one hundred and eighty) days starting from the moment the Gift Me Crypto Voucher has been delivered; the ability of the Consumer to use the Gift Me Crypto Voucher for the first time will be considered to constitute the delivery for the purposes of these GTCs. Upon expiration of the Gift Me Crypto Voucher validity time, you lose the option to redeem the Gift Me Crypto Voucher. By not redeeming the Gift Me Crypto Voucher in the form of a Conversion during its validity, you express your tacit consent to the transfer of the Nominal Value in favour of the Provider.

6.10. The Consumer is aware and agree that the conversion rate of the Cryptocurrency may change significantly after the Conversion has been executed and that the Provider is not liable for this situation.


7. DISTRIBUTORs

7.1. In order to make its Services available to as many Consumers as possible, the Provider cooperates with Distributors to expand the list of payment methods with methods which are not provided by the Provider itself. After successful registration on our Website, natural or legal persons may choose an option ´I WANT TO BECOME A DISTRIBUTOR´ by which they proceed with creating a profile of a Distributor, where they can upload a profile picture and add information on what method of payment they will provide the Consumers with.

7.2. By creating a profile according to clause 7.1 of these GTCs, the Distributor will be included in the list of Distributors displayed to Consumers when choosing the method of payment for the Gift Me Crypto Voucher.

7.3. In case the Consumer chooses to pay for the Gift Me Crypto Voucher through payment method provided by the Distributor, the legal relationship between the Distributor and Consumer will be modified by provisions agreed by them via online chat provided by Provider on his Website.

7.4. Provisions agreed by the Distributor and Consumer include payment instructions as well as the amount of Distributor´s fee for providing such payment.

7.5. After the Consumer successfully executes the payment, the Distributor verifies the payment made by payment method he has provided the Consumer with and informs the Provider of this fact through a Website functionality, stating that the transaction has been paid. 7.6. In the event that the Provider, Distributor or Consumer later finds out that the payment has not been made properly or in accordance with provisions of these GTCs or mutual agreement between the Distributor and Consumer, the liability for such defects of payment shall be applied as follows:

(a) the Provider asserts claims for incorrect fulfilment of its obligations or provision of incorrect information by the Distributor, to the Distributor;
(b) the claims arising from the mutual rights and obligations of the Distributor and the Consumer are asserted by these parties exclusively between themselves, as their relationship the subject of which is the provision of payment for the Gift Me Crypto Voucher, presents an individual and separate legal relationship to which the Provider is not a contractual party.


7.7. The Provider attempts a proper process of selling Gift Me Crypto Vouchers and therefore in the case of resolving claims under clause 7.6 letter b of these GTCs, the Provider will involve a Moderator in the process of resolving complaints and other claims arising from defects arising from the relationship between the Distributor and the Consumer. In the event that the actions of the Moderator will not be sufficient to resolve the complaint, the Consumer will be obliged to assert all other claims, the subject of which is the application of defects from the service provided by the Distributor, exclusively to the Distributor.

7.8. For the avoidance of any doubt, the Provider states that if the Consumer chooses the method of payment provided by the Distributor, he enters a contract with a third party, the relationship with whom is based on their mutual agreement.


8. GIFT ME CRYPTO VOUCHER RESTRICTION

8.1. The Provider reserves the right to temporarily or permanently restrict the Gift Me Crypto Voucher purchased by the Consumer if:

(a) the Consumer is using the Gift Me Crypto Voucher in violation of the law or in violation of the provisions of the GTCs and the Agreement;
(b) Gift Me Crypto Voucher was acquired in violation of the law;
(c) the Gift Me Crypto Voucher validity time has expired pursuant to clause 6.9 of these GTCs.


8.2. The Gift Me Crypto Voucher cannot be used to purchase another Gift Me Crypto Voucher. The Gift Me Crypto Voucher cannot be changed for FIAT currency.

8.3. The Gift Me Crypto Voucher cannot be used to purchase goods and services.

8.4. The Gift Me Crypto Voucher cannot be restricted or blocked by the Consumer until the Provider has granted its consent to the same.


9. PROVISION OF SERVICES

9.1. The Provider undertakes to provide Consumer Conversion services and Custody services under conditions set out in these GTCs.

9.2. The provision of Conversion services include conversion of FIAT currency into Cryptocurrency by means of Gift Me Crypto Voucher, conversion between Cryptocurrencies as well as conversion of Cryptocurrency into FIAT currency in case you request for withdrawal of Cryptocurrency.

9.3. The Provider also provides Consumer with Custody services in relation to Cryptocurrencies belonging to Consumer to ensure their protection.

9.4. Custody services are provided in a manner that enables secure custody and protection of Cryptocurrencies against theft, loss, or accidental destruction in relation to the data required for the handling of Cryptocurrencies.


10. FEES

10.1. Provision of the Services is charged according to the current fees for services (the “Fees”). The Provider reserves the right to set off any due Fees and expenses or other receivables related to the provision of the Services against the Consumer unilaterally.

10.2. The Provider reserves the right to change the Fees or introduce new fees related to the provision of the Services. The Provider is entitled to amend the Fees or alter the Fees of individual items with the effectiveness of 14 days from the delivery of notification on this amendment to the Consumer’s e-mail address. The new Fees shall take effect on the 14th day from the delivery of the notification on the amendment of the Fees to the Consumer.

10.3. Fees are calculated as a percentage per transaction and/or as a flat fee. Fees also include fees for services provided to Fintegence by third party service providers.

10.4. Withdrawal fee is a fee charged to Consumer for each withdrawal of Cryptocurrency or transfer of Cryptocurrency made by Consumer.

10.5. Payment fee is a fee charged to Consumer for (i) processing of each Consumer's payment when purchasing a Gift Me Crypto Voucher and (ii) for execution of Conversion.

10.6. Prior to confirming the redemption, a summary page will be presented to the Customer displaying the applicable rate and the amount of cryptocurrency after deducting all fees. The Customer will have the opportunity to review and approve the provided rate during the voucher redemption process.

10.7. Buying in Fiat currency, deposits and withdrawals are subject to daily, weekly, monthly and yearly limits as stipulated in section Fees and limits on the Webpage

10.8. Voucher redemption fee is 9% plus appropriate network fee that is calculated dynamically based on current market conditions. Network fee depends on many factors such as network & cryptocurrency chosen by the user and current network load.

10.9. Final fees are always shown on the summary page before finalizing voucher redemption


11. WITHDRAWAL AND TRANSFER OF CRYPTOCURRENCIES

11.1. The Consumer is entitled to request the withdrawal or the transfer of Cryptocurrency which was acquired in provision of Services or any of its parts at any time (“Withdrawal request”).

11.2. In order to perform the withdrawal or the transfer of Consumer’s Cryptocurrency, the Consumer is obliged to use transfer function available in the Account and follow the relevant instructions.

11.3. The Provider undertakes to process Withdrawal request without undue delay, but not later than within 2 business days following receipt of Withdrawal request.

11.4. The Provider will transfer:

11.4.1. the amount acquired from selling the Consumer’s Cryptocurrency under Withdrawal request, to the bank account address of the Consumer which was verified as belonging the Consumer in question; and
11.4.2. the Cryptocurrency to the address specified by Consumer.


12. WITHDRAWAL FROM THE AGREEMENT

12.1. If the Agreement has been entered into through distance communication means, i.e. through the Website, you may withdraw from the Agreement within 14 (in words: fourteen) days of the delivery of the Gift Me Crypto Voucher pursuant to clause 6.9 of these GTCs without the cause. However, the right to withdraw from the Agreement applies solely to the purchase of the Gift Me Crypto Voucher and only if the Gift Me Crypto Voucher has not been redeemed in the form of a Conversion.

12.2. If you are interested in executing a Conversion during the withdrawal period pursuant to clause 12.1, from the moment you grant the Provider your explicit consent to the execution of the Conversion before the expiry of the withdrawal period, you lose the right to withdraw from the Agreement. You hereby expressly approve the start of execution of the Conversion before expiry of the withdrawal period.

12.3. If we fail to satisfy the terms and conditions of clauses 12.1 and 12.2 of these GTCs, you have the right to withdraw from the Agreement as permitted by the applicable law, i.e. within 14 (in words: fourteen) days of the entering into of the Agreement. You can withdraw from the Agreement by using the Agreement withdrawal form or by sending an e-mail at: [email protected], and we must refund the entire Nominal Value of the Gift Me Crypto Voucher to you.

12.4. The right to withdraw from the Agreement pursuant to this Article 12 does not apply to the Consumers outside the European Union.


13. LIABILITY OF THE PROVIDER

13.1. We strive to ensure continuous provision of Services on the Website and their uninterrupted availability. Our servers meet the highest standards of security and serviceability to make these Services available whenever you need them. However, we will not be liable for the failures that we cannot influence in cases of objective and unavoidable technical obstacles or other facts that make it impossible for us to perform. However, we use our best efforts to promptly resolve any existing obstacles.

13.2. We also reserve the right to be not liable for any damage or harm suffered as a result of any interruption or termination of provision of the Services.

13.3. All services related to the possession of the Gift Me Crypto Voucher and its Conversion will always be properly provided. However, our company has the right to terminate its business, provision of Services and operation of the Website or its part at any time and to not enter into new Agreements with further Consumers.

13.4. For your safety, all data stored on our servers is backed up. The Provider is not liable for the loss, damage or removal of any information, records, visual recordings, data, communications or any other information entered by the Consumer into its Account if this consequence was caused by the Consumer, for example by an ill-judged deletion of data or intentionally.

13.5. We are also not liable for the consequences caused by force majeure, which may consist in the following events:

(a) protests, strikes, power outages, fire, interruption of Internet connection, cataclysm, armed conflict;
(b) terrorist attack and the related circumstances; (c) damage to the Provider’s registered office or business premises causing its inability to provide Services;
(d) unavailability of Services related to the availability of the Cryptocurrency market or Conversion services;
(e) unavailability of Services or their parts within a particular Cryptocurrency market due to the application of specific measures that make it impossible to execute a Conversion;
(f) unavailability of telecommunications services or Internet connection due to an obstacle on the part of their provider;
(g) obstacles due to a failure of IT systems creating an obstacle in the provision of the Provider’s services.


13.6. The Provider is liable for the performance of the Agreement and these GTCs to the extent stipulated in them.

13.7. The Provider is not liable for cases in which its liability is excluded by virtue of law, the Agreement or the GTCs.

13.8. The Provider is not liable for the loss, destruction or misuse of the Gift Me Crypto Voucher by an unauthorised person or for any financial, property and any other damage caused to the persons concerned in cases where this occurred outside the Provider’s control.

14. CLAIM AND COMPLAINTS

14.1. Our company is making every effort to satisfy our Consumers. If there is a failure in the provision of our services or any defect, for example when the Gift Me Crypto Voucher is redeemed, you can file a claim and send it to our e-mail address: [email protected] .

14.2. We will deal with your claim and resolve it within 30 (in words: thirty) days of its receipt. If your complaint is not resolved within this deadline, you have the right to a refund, provided that the complaint relates to a financial value so specified.

14.3. The Consumer may contact the Provider with a request for remedy if the Consumer is not satisfied with the manner in which the Provider resolved the Consumer’s Claim or if the Consumer believes that the Provider violated his/her rights. The Consumer may submit an application for an alternative dispute resolution with an alternative dispute resolution entity if the Provider rejected its request under the preceding sentence or failed to respond to the request within 30 (in words: thirty) days of the date of its dispatch. The Consumer submits the application with the relevant alternative dispute resolution entity, without prejudice to the Consumer’s right to refer the dispute to a court.

14.4. The application may also be submitted through the Platform for Alternative Resolution of Consumer Disputes available at https://webgate.ec.europa.eu/odr/main/?event=main.home.show.

14.5. We accept any suggestions, complaints and claims from our customers at our mailing address specified in the heading of these GTCs and at the e-mail address [email protected] .

14.6. Warning Disclaimer. Cryptocurrencies are holding many risks such as:

- Risk of depreciation in value & volatility. Cryptographic digital information stored in blockchain are not regulated and can experience high volatility in price as well as decline their value to zero.
- Market, technology, community. Since cryptographic digital information are generally not governed or regulated there is risks of soft/hard forks, changing in technologies, possible hacks, cryptocurrency splits and other consequences of technological changes. Fintegence does not hold any responsibility for those risks as they're beyond control of Fintegence and they depend on all market participants. By using services provided by Fintegence, Consumer understands and accepts those risks.


15. COMMUNICATION, NOTICES AND DELIVERY

15.1. The Parties agree that in the case of delivery of mutual correspondence, delivery under these GTCs means delivery of a written content to the e-mail address [email protected] . or by registered mail or courier to: Fintegence, s.r.o., with its registered office at Bottova 2A, 811 09 Bratislava – mestská časť Staré mesto, Slovenská republika. The date of delivery also means the date on which a Party refuses to accept the document being delivered or the day of return of the parcel containing the words “the addressee has not taken over the delivery within the take-over deadline”, “the addressee has moved”, “the addressee is unknown” or any other note of similar meaning. In the case of electronic delivery of documents by e-mail, a document is deemed to have been delivered on the day following the day on which it was dispatched. For the purposes of delivery by mail, the addresses of the Parties specified in the Agreement (Order) or the electronic order form will be used, unless the addressee of the documents notified the dispatching Party of a new address of its residence or a new e-mail address for delivery of documents.

16. RESOLUTION OF DISPUTES AND JURISDICTION OF COURTS

16.1. The Parties agree that any disputes arising in connection with the fulfilment of obligations under the Agreement will be preferably resolved out of court by negotiation or by mutual agreement. Should the Parties fail to resolve their disputes out of court, the Parties may resolve such disputes through the courts in accordance with the applicable laws of the Slovak Republic. The local jurisdiction of the court is given in accordance with Act No. 160/2015 Coll., the Code of Civil Contentious Procedure, as amended.

17. CHANGES TO THE GTCs

17.1. We reserve the right to change these GTCs at any time during the term of the Agreement or the use of the Services. This change can usually take place for the following reasons:

(a) a change in the laws related to our Services requiring a change to the GTCs;
(b) issue of case law, recommendations, opinions and other documents relevant for the provision of our Services by the competent authorities;
(c) if we add new products and services that, for technical reasons, may change the function and the way we perform our Services.


17.2. We shall be entitled to freely assign our rights and obligations under these GTCs to any third party and your consent for such assignment shall be considered as granted by virtue of these GTCs provided that such transfer or assignment would not have a material effect on the quality or content of the Services provided.

17.3. We shall be obliged to inform you of such an assignment two months before it enters into effect. If you do not express your disagreement with the proposed assignment by its effective date, Fintegence shall assume that the assignment has been accepted. You shall be entitled to terminate the Agreement with us immediately free of charge should you do not agree with the proposed assignment of our rights and obligations.

17.4. The other Party (other than Fintegence) may not assign any of its rights and obligations under these GTC to third parties without the prior written consent of Fintegence.


18. SUPERVISION AUTHORITY

The Provider's supervision authority is:

Inspectorate of the Slovak Trade Inspection
Bajkalská 21/A Bratislava – Ružinov, 827 99Slovak Republic
Place: Bratislava, Slovak Republic Date: 15 January 2024


WITHDRAWAL FORM

(FILL IN AND SEND THIS FORM ONLY IF YOU WISH TO WITHDRAW FROM THE AGREEMENT)

To:

Fintegence, s.r.o.
Bottova 2A, 811 09 Bratislava – mestská časť Staré mesto
Slovak republic
Identification No.: 47 956 925
registered in the Commercial Register of the District Court Bratislava III
section: Sro, insert No.: 171365/B
E-mail: [email protected] 

I hereby / We hereby announce* that I am / we are withdraw* from the agreement for the following goods / the agreement on the provision of the following services and works*:
Date of order / Date of receipt*:
Name and surname, address of consumer / consumers*
Date:Signature of the consumer / consumers* (only if this form is submitted in the physical form)