Sample withdrawal form
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This English text is a courtesy translation. In case of any discrepancy, the Czech version of this page prevails.
This form can be used by consumers who wish to withdraw from a service contract concluded with me by distance means, within the period and under the conditions set out in clause 13 of the terms and conditions.
It is based on the model instructions and withdrawal form under Czech Government Regulation No. 29/2023 Coll. Using it is not mandatory — withdrawal can be made by any clear statement sent to ahoj@semakod.cz. If filling it in makes things easier for you, feel free to use it — just fill it in and send it to the same email address.
Addressee
Mykola Stoyka, company registration number (IČO) 01796763, registered at Radimovická 1423/31, Chodov, 149 00 Prague 4, email: ahoj@semakod.cz
Notice of withdrawal from the contract
I hereby give notice that I withdraw from the contract for the provision of the following service:
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Date ordered:
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Name and surname of the consumer:
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Address of the consumer:
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Email of the consumer:
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Date:
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Signature of the consumer (only if this form is sent on paper):
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