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Cancellation Form

To OME Medical Education Academy UG (haftungsbeschränkt), Leipziger Platz 15. (5 OG), 10117 Berlin,
E-Mail: office@premedicine-berlin.de,

I / We [*] hereby give notice that I / We [*] cancel my / our [*] contract of sale of the following goods [*] / for the supply of the following service [*],

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

print CANCELLATION INFORMATION

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