MODEL WITHDRAWAL FORM

(Please complete and return this form only if you wish to withdraw from the contract.)

For the attention of: 2012lab'o sarl, rue des grands prés, le Haras- 27150 Bouchevilliers – infos@2012labo.fr :

I/we (*) hereby notify you (*) of my/our (*) withdrawal from the contract for the sale of the goods (*)/for the provision of services (*) below:

Ordered on (*)/received on (*):

Name of consumer(s):

Address of consumer(s):

Signature of consumer(s) (only in case of notification of this form on paper):

Date:

(*) Delete as appropriate.

In accordance with Article 2 of Decree No. 2022-424 of 25 March 2022, these provisions enter into force on 28 May 2022.