Withdrawal from the contract

Pure Legacy sro, IČO: 14001781, _cc781905-5cde-3194- bb3b-136bad5cf58d_

Prague - Krč, Pod višňovkou 1661/33, zip code 140 00

Company: Pure Legacy s.r.o

Registered office: Prague - Krč, Pod višňovkou 1661/33, ZIP code 140 00

ID/TIN: 14001781

I hereby declare that I withdraw from the contract for the purchase of these goods:

• _cc781905-5cde- 3194-bb3b-136bad5cf58d_ Date Ordered (*)/Date Received (*):

• _cc781905-5cde- 3194-bb3b-136bad5cf58d_ Order number:

• _cc781905-5cde- 3194-bb3b-136bad5cf58d_ Funds for ordering, possibly also for delivery, were sent via (*)

and will be returned in the following manner (in case of transfer to an account, please send the account number) (*)

• _cc781905-5cde- 3194-bb3b-136bad5cf58d_ Name and surname of the consumer:

• _cc781905-5cde- 3194-bb3b-136bad5cf58d_ Consumer address:

• _cc781905-5cde- 3194-bb3b-136bad5cf58d_ Email:

• _cc781905-5cde- 3194-bb3b-136bad5cf58d_ Phone:

V _cc781905-5cde- 3194-bb3b-136bad5cf58d_ , On

________________________________________

_cc781905-5cde-3194 -bb3b-136bad5cf58d_ Name and surname of the consumer

(*) Cross out those that do not apply or complete the data.