Model Withdrawal Form
Effective date: 11 October 2026
Complete and send this form only if you wish to withdraw from your contract. You may also send any other clear written statement of withdrawal; this form is not mandatory when the law accepts a clear statement.
To:
Individual Entrepreneur VALERIIA GERIUGOVA
Georgia, Batumi, Giorgi Leonidze Street, No. 4e, Building No. 2, 6th Floor, Apartment No. 75
Client notice
I hereby give notice that I withdraw from my contract for the following online educational Program:
Program / order reference: ________________________________________
Ordered on / contract date: ________________________________________
Client name: _____________________________________________________
Client address: ___________________________________________________
Email used for purchase: ___________________________________________
Date: ____________________________________________________________
Signature (only if this form is sent on paper): _________________________
Where withdrawal rights apply, the relevant period is ordinarily counted from contract conclusion for services, subject to the applicable statutory rules. Contact us at y.valerie98@gmail.com for questions.