MODEL WITHDRAWAL FORM FOR A DISTANCE CONTRACT AND A CONTRACT CONCLUDED OUTSIDE THE TRADER’S BUSINESS PREMISES

(Complete and return this form only if you wish to withdraw from a distance contract or from a contract concluded outside the trader’s business premises.)

To:
NINE SPORT s. r. o.
with registered office at Ambrova 33, 831 01 Bratislava
Company ID (IČO): 51 698 994
Tax ID (DIČ): 2120760323
VAT ID: Not a VAT payer
registered in the Commercial Register of the Municipal Court Bratislava III
Section: Sro
File No.: 128373/B
e-mail: app@healthprofile.digital
phone number: +421 907 899 003

I hereby give notice that I/we* withdraw from the contract for the provision of services ordered on the platform:

https://healthprofile.digital/diagnostika/
https://hilbi.com/sk/profile/health-profile/order/package

Name of the service
………………

Date of order / date of receipt*
………………

Name and surname of the consumer / consumers*
………………

Address of the consumer / consumers*
………………

Signature of the consumer / consumers*
(if this form is submitted in paper form)
………………

Date
………………

*Strike out what does not apply.