Model Withdrawal Form

Model Withdrawal Form

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

 To: Riot Games Ireland Merchandise Limited,
       C/O arvato distribution GmbH
       Betriebsstatte HC 4/Fa. 897
       BenzstraBe 9-15
       D-33442 Herzebrock-Clarholz

 -- I/We (*) hereby give notice that I/We (*) withdraw from my/our (*) contract of sale of the following goods (*)/for the provision of the following service (*),

-- Ordered on (*)/received (*),

-- Name of consumers(s),

-- Address of consumer(s),

-- Signature of consumer(s) (only if this form is notified on paper),

-- Date

(*) Delete as appropriate.