TO: .............. (name of merchant) | |
.............. | |
.............. (address of merchant) | |
Date: .............. (date on which form is sent) | |
Under section 193 of the Consumer Protection Act, I cancel the contract (No. ..............) (contract number, if any) | |
entered into on .............. (date when contract was entered into) | at .............. (place where contract was entered into) |
.............. (name of consumer) | |
.............. (signature of consumer) | |
.............. | |
.............. (address of consumer) |