Sample cancelation form

(If you wish to cancel the Agreement, please complete this form and return it.)

- To
XS News B.V.
Customer Support
New Yorkstraat 10-16
1175 RD Lijnden
Nederland.
E-Mail: support@xsnews.nl

- I/we (*) hereby cancel the Agreement entered into by me/us (*) for the provision of the following

service (*)

- Ordered on (*)/received on (*)

- Name of consumer(s)

- Address of consumer(s)

- Email address of consumer(s)

- Username of consumer(s)

- Signature of consumer(s) (only where notification is on paper)

- Date

___________

(*) Delete if inapplicable.

End of sample cancelation form