Withdrawal Form

Location / Date

Esteemed

UCapital24 s.r.l.

Corso Giacomo Matteotti 1/A

20121 - Milano

sent via e-mail to: premium@ucapital24.com

or

via registered letter

Hereby the undersigned _________________________(insert name and surname of the client who has terminated the contract), with the dispatch of this module notifies the withdrawal from the sale contract of the following service (specific description of the purchased service) ______________, purchased on ______________ (insert the contract’s termination date).

Simultaneously I do request the reimbursement of the payments I did execute, through ___________________________ (insert payment method utilized to pay the price, for instance: bank transfer – IBAN code (in case of national bank transfer insert the IBAN code; in case of international bank transfer add the BIC code) or for example refund on the credit card utilized for the payment, only if effectively entitled to based on the general sales conditions.

Kind Regards

________________________