Model withdrawal form
Complete and return this form only if you wish to withdraw from the contract.

To:
SIA “Kompānija NIKAN”
Buļļu iela 40B - 38, Rīga, LV-1055
info@dzese.lv

I/We hereby give notice that I/We withdraw from the contract of sale of the following goods / provision of the following service (delete as appropriate):

Goods / service: __________________
Ordered on / received on: __________________
Name of consumer(s): __________________
Address of consumer(s): __________________
Signature of consumer(s) (only on paper): __________________
Date: __________________