# Directive 2011/83/EU of the European Parliament and of the Council of 25 October 2011 on consumer rights, amending Council Directive 93/13/EEC and Directive 1999/44/EC of the European Parliament and of the Council and repealing Council Directive 85/577/EEC and Directive 97/7/EC of the European Parliament and of the Council (Text with EEA relevance), Division B: Model withdrawal form

Extent: E+W+S+N.I.

(complete and return this form only if you wish to withdraw from the contract)
To [here the trader’s name, geographical address and, where available, his fax number and e-mail address are to be inserted by the trader]:
I/We hereby give notice that I/We withdraw from my/our contract of sale of the following goods/for the provision of the following service,
Ordered on/received on,
Name of consumer(s),
Address of consumer(s),
Signature of consumer(s) (only if this form is notified on paper),
Date

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Source: https://www.legislation.gov.uk/eudr/2011/83/annex/I/division/B (the official version)
Page: https://openlegislation.uk/eu-directive-2011-83/annex-I/division-B
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.