Annex 2 to Book VI Code of Economic Law

Model of retraction form

Please print, complete and return this form only if you wish to withdraw from the contract. You must copy and paste and print the required information below or send us an email to receive the Word document in return.

To the attention of:

Pom de Pin Belgium - rue de Warnoumont, 50b - B-4140 Sprimont, Belgium

04/382.21.41 - info@pomdepin.be

Pom de Pin France c/o SARL DESMAZIERES DRINO BONNETERIE FABRICATION - Parc d'activités de la Houssoye - Bâtiment H07 - 9, rue Irène Jolliot-Curie F-59930 La Chapelle d'Armentières, France

03 20 35 02 23 - info@pomdepin.fr

• I/We hereby notify you  my/our* withdrawal from the contract for the sale of the goods below:
• Ordered */received on *:
• Name of the consumer(s):
• Full address of the consumer(s):
• Signature(s) of the consumer(s) (only in case of notification with this paper form):

(*) Delete as appropriate