(Complete and return this form only if you wish to withdraw from the contract)

To Ceuta Healthcare, C/O The Stork Ib2C Inc., Hill House, 41 Richmond Hill, Bournemouth, Dorset, BH2 6HS
TELEPHONE NUMBER: 0344 243 6661 FAX NUMBER: 0344 243 6662 E-MAIL ADDRESS: customerservices@ceutahealthcare.com.

Cancellation Form