Retraction form

Annex 1 - Cancellation form

In case of withdrawal of your order placed on ICA - L’Energie Créatrice, please complete and return this form - except exclusions or limits to the exercise of the right of withdrawal according to the applicable General Conditions of Sale.

For the attention of ICA - 303 B CHAUSSEE ROYALE - 97460 SAINT PAUL, LA REUNION-FRANCE

I hereby notify you of my withdrawal from the contract for the sale of the goods / for the presentation of service (*) below:

Ordered on …………………………………… .. / Received on ……………………………………………………………… .. (*)

Order number: …………………………………………………………………… ..

Name of consumer (s): ……………………………………………………………… ..

Address of the consumer (s): ……………………………………………………………… ..

Signature of the consumer (s) (only if this form is notified on paper):

Date: …………………………………………………………………… ..

(*) Delete the unnecessary mention