Model Withdrawal Form
Complete and return this form only if you wish to withdraw from the contract. You can also declare your withdrawal directly using the Cancel contract function — that is the quicker route, and you receive an acknowledgement immediately.
To:
Xenia Beliayeva
Helenenstraße 16
22765 Hamburg
Germany
Email: xenia@beliayeva.com
I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods:
____________________________________________________
Ordered on (*) / received on (*): ____________________
Name of consumer(s): _________________________________
Address of consumer(s): ______________________________
____________________________________________________
Signature of consumer(s), only if this form is notified on paper:
____________________________________________________
Date: ______________________________________________
(*) Delete as appropriate.
The full conditions and deadlines are set out in the Right of Withdrawal.
Last updated: 7 October 2026