MODEL WITHDRAWAL FORM — JAN VALENTA COACHING

Complete and send this form only if you wish to withdraw from a coaching contract.
Using this form is optional. A clear statement by email or post is sufficient.
Downloading or editing this file does not submit it.

To: Jan Valenta, IČO 17666180
Družstevní 352, 273 64 Doksy, Czech Republic
Email: ttvalenta@gmail.com

I hereby give notice that I withdraw from my contract for private 1-on-1
online table-tennis coaching.

Plan / contract reference (if known):
Date the contract was concluded:
Customer name:
Customer address:
Purchasing email (to help identify the contract):
Date:
Signature (only if sent on paper):

Send your completed statement to the email or postal address above.
You do not need to give a reason.