Model Withdrawal Form

Use this form only if you wish to withdraw from a contract where a right of withdrawal is available. You do not have to use this form if you otherwise send us an unequivocal statement of withdrawal.

To: BELL UGT LTD Alexandreias 2-4, Bridge Tower, Flat/Office 3A, 3013 Limassol, Cyprus Contact: our contact details

I/We hereby give notice that I/We withdraw from my/our contract for the following eSIM service:

Order number: ______________________________________

Plan / destination: __________________________________

Date ordered: _______________________________________

Name of consumer(s): ________________________________

Email used for order: ________________________________

Address of consumer(s), if required: ________________________________________________________

Signature of consumer(s), only if submitted on paper: ________________________________________________________

Date: ______________________________________________

If the eSIM has already been installed, activated or used, please state this so that we can assess the request correctly under the applicable withdrawal and digital-service rules:

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