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Repentance form

This form must be used when you want to cancel an agreement, according to the rules in the Act on distance agreements and
agreements outside business premises (SFS 2005:59). You also have the option to change your mind in a different way than using the
form, but it is always recommended to save documents that show you have changed your mind.

Repentance form template

The form must be filled in and returned to the address below if you wish to cancel the agreement.

Contact information
Name
Hi3G Access

Address
Box 7012, 121 07 Stockholm-Globen

Email (if applicable)

kundservice@tre.se

Customer information
Name Social security number

Name 2 (if there are more of you who made the purchase) Social security number

Address

Telephone number (*) Email (*)

I/We (*) hereby announce that I/We (*) withdraw from my/our (*) purchase agreement regarding the following goods
(*) / services (*)

Ordered (date) (*) Received (date) (*)

Place Date

Signature (only applies to paper form) Signature 2 (if there are more of you who made the purchase)

(*) Cross out what does not apply.

Repentance form template. The content is based on Annex 1 of Directive 2011/83/EU.