Withdrawal Form

Sample Withdrawal Form

English translation for information only. The legally binding version of this document is the Polish one. In case of any discrepancy, the Polish version prevails. A Consumer (as well as a sole trader with consumer rights) may withdraw from a contract concluded at a distance within 14 days of receiving the goods, without giving a reason. Using the form below is voluntary — any clear declaration sent before the deadline expires is enough. You can print the form, fill it in and send it by post, or copy its content into an e-mail.

Withdraw from the contract online

The easiest way: submit your statement via the online form. Enter the order reference and the e-mail address used for the order (logged-in customers will find the button in the order details). We will e-mail you a confirmation with the date and time of submission.

Withdraw from the contract

Fiscal devices cannot be returned once fiscalised

Fiscalisation is a one-off and irreversible operation. The fiscal memory of the device is permanently written with the taxpayer's tax number, and the device is registered with the tax office and given a registration number. Such a device cannot be restored to its pre-fiscalisation state or assigned to another taxpayer.

For this reason the right of withdrawal does not cover fiscal cash registers and printers that have been fiscalised, whether or not they have been used. Returns are possible only for non-fiscalised devices that are complete, undamaged and in their original packaging.

Template consistent with Appendix No. 2 to the Act of 30 May 2014 on Consumer Rights.

(this form should only be completed and sent back if you wish to withdraw from the contract)

Addressee:
ALFA SYSTEM Alicja Włodarczyk
ul. Zemborzycka 53, 20-445 Lublin
NIP 9461117762
e-mail: biuro@alfasystem.lublin.pl

I/We(*) hereby give notice that I/we(*) withdraw from my/our sales contract for the following items(*) the contract for the delivery of the following items(*) the contract for the performance of the following work(*)/the provision of the following service(*):

 

 

Date the contract was concluded(*)/received(*):  

Order number (optional):  

Name(s) of the consumer(s):  

Address of the consumer(s):  

Bank account number for the refund (optional, if payment was cash on delivery):  

Signature of the consumer(s) (only if the form is sent in paper form):  

Date:  

(*) Delete as appropriate.

How to Return the Goods

  1. Send your declaration of withdrawal by e-mail to biuro@alfasystem.lublin.pl or by post to the address given above.
  2. Send the goods back within 14 days of your withdrawal to: ALFA SYSTEM Alicja Włodarczyk, ul. Zemborzycka 53, 20-445 Lublin. The consumer bears the direct cost of returning the goods.
  3. We will refund all payments received, including the cost of the cheapest delivery option offered, within 14 days of receiving your declaration — using the same payment method you used for the purchase. We may withhold the refund until we receive the goods or proof that they have been sent back.

Exceptions to the right of withdrawal (e.g. software in opened packaging, licences after performance has begun, goods made to the customer's specification) and the remaining rules are described in §8 of the shop's Terms and Conditions.