(Complete and return this form only if you wish to withdraw from the contract.)

To: Dutch Onderzoeksmiddelen, trading as Dutch Peptide Labs, Wilhelminaplein 1-40, 3072 DE Rotterdam, the Netherlands, store@dutchpeptidelabs.nl

I/We* hereby give notice that I/We* withdraw from my/our* contract of sale of the following goods:

• Product(s): ……………………………………
• Order number: ……………………………………
• Ordered on* / received on*: ……………………………………
• Name of consumer(s): ……………………………………
• Address of consumer(s): ……………………………………
• Signature of consumer(s) (only if this form is notified on paper): ……………………………………
• Date: ……………………………………

* Delete as appropriate.