Please copy this form into an email, complete it, and return it to [email protected] only if you wish to withdraw from the contract.

To the attention of MAX PICCININI COACHING DMCC, whose registered office is located at Unit No. 3O-OO-D1-12, Jewellery & Gemplex 3, Plot No. DMCC-PH2-J&GPlexS, Jewellery & Gemplex, Dubai, United Arab Emirates. ([email protected]).

I hereby notify you of my withdrawal from the contract for the sale of the goods/services below:

Contract Number:

Identification of Goods/Service: Ordered on:

Consumer Name:

Consumer Address:

Consumer Telephone

Number:

Consumer Email:

Date: