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Withdrawal/Termination statement sample

Annex 2 to 45/2014. (II. 26.) to Government Decree

(fill in and return only in case of intention to withdraw/terminate the contract)

To: (1)

I/we, the undersigned, declare that I/we exercise my/our right of withdrawal/termination with respect to the contract for the sale of the following product/s or the provision of the following service: (2)

Date of conclusion of contract / date of acceptance:

Name of the consumer(s):

Address of the consumer(s):

Signature of the consumer(s): (only in the case of a statement made on paper)


(1) It is necessary to indicate the name, postal address and, if available, the telephone number, fax number and electronic mail address of the business.

(2) Indicator of products to be returned

A signature is only required for declarations made on paper.

The relevant law can be found here:

The withdrawal statement sample can be downloaded from the following link: Cancellation statement