Withdrawal form sample

To the attention of ANDRÉS ORTIZ SAÚCO
Avenida del Manzanares, 202, 1º B, 28026 Madrid, Spain

info@cepic.es

I hereby notify you that I withdraw from the following contract for the provision of services:

– Specify course name:

– Name of the consumer and user:

– Address of the consumer and user:

In ________ , on ___ of ________ of the year _____________

Signature of the consumer and user