Declaration of revocation

Sender:

Michaela Pattern

Sample route 1

99999 Model City

At:

[Company name and address] Date

Cancellation of my contract

Customer number/order number:

Ladies and Gentlemen

I hereby revoke the contract I have concluded:

[Insert as detailed a description as possible of the goods or services purchased, i.e

e.g. Internet or telephone contract, memberships in fitness studios, portals, social networks]

I ask for immediate confirmation of my revocation.

[optional: revocation of consent to the processing of personal data:]

Furthermore, as a precautionary measure, I hereby revoke my consent in accordance with Article 7 Paragraph 3 Sentence 1 GDPR

in the processing of my personal data, provided this has been validly granted.

I request that you immediately return my personal data stored with you

delete, Art. 17 Para. 1 b) GDPR. If you send my personal data to other recipients

have disclosed, I also request that you inform the recipients about the deletion of my

inform personal data.

I ask for immediate confirmation that my personal data will be deleted from you

and that you inform the other recipients by sending a copy via my

informed about the request for deletion.

If you do not comply with my deletion request, I ask you to send your

Decision to me immediately, stating the legal basis

justify. In this case, the relevant data must be blocked immediately.

Best regards

(Signature)