Refund request

First name*

Last name*

Email* The email address linked to your member account. We use it to identify your contract.

Phone*

Contract number* The number of the contract you want to withdraw from. You can find it in the confirmation email you received at purchase.

Contract value*

RON

The amount displayed on the contract, which you are requesting to be refunded.

Date *

The date the contract was issued.

IBAN* The IBAN of your bank account where the amount will be returned if the withdrawal is approved.

Reason*

By checking the box, I hereby declare that I understand and acknowledge the terms and conditions. Terms and conditions

I confirm that I consent to the processing of the personal data provided in this form so that I can be contacted regarding my request

Withdraw from your contract