If you wish to revoke the contract concluded with VivoSensMedical GmbH, please complete this form and return it to:

VivoSensMedical GmbH
Limburgerstr. 74 C
04229 Leipzig

or

e-mail: info@ovularing.com

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I/we hereby revoke the contract concluded by me/us for the purchase of the following goods/provision of the following service:

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(name of the goods, if applicable order number and price)

ordered on: ………………………………………………

received on: …………………………………………….

Reason for revocation:

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Name and address of consumer:

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Place/date Customer signature