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Model withdrawal form

Effective: May 23, 2026

Fill in and send this form only if you wish to withdraw from your contract with SimplyForms within the 14-day period under §1829 of the Czech Civil Code. The template follows the model in Annex 2 to Government Regulation No. 363/2013 Coll.

Note — §1837(l) of the Czech Civil Code: If at paid-plan activation you ticked the separate consent to immediate commencement of the digital service before the 14-day period expires, your right to withdraw under §1829 was forfeited at the moment performance commenced. See §17.3 of the Terms of Service.

Addressee

Adam Todt Business ID (IČO): 19197438 Tax ID (DIČ): CZ8909294592 (identified person, NOT a VAT payer) Drahy 1625, 696 42 Vracov, Czech Republic Email: legal@simplyforms.app

Notice of withdrawal

I hereby give notice that I withdraw from my contract for the provision of the following service:

Service: SimplyForms — Form Backend as a Service

Plan: (fill in: FREE / STANDARD / EXTEND / ENTERPRISE)

Contract date (registration): ___________________________________________

Paid-plan activation date (if applicable): ______________________________

Form ID: ______________________________________________________________

Account email: ________________________________________________________

Consumer name: ________________________________________________________

Consumer address:

Consumer email (if different from account email): ______________________

Date: _________________________________________________________________

Consumer signature (only if this form is sent on paper):

Delivery options

  1. Email (recommended): scanned or photographed completed form, or plain text, to legal@simplyforms.app
  2. Postal mail: Adam Todt, Drahy 1625, 696 42 Vracov, Czech Republic

We will send an email acknowledgement of receipt without undue delay.

Consequences of withdrawal

On successful withdrawal:

  • The Account will be deactivated and the API key invalidated as of the effective date.
  • Refund of paid Fees (paid plans): within 14 days of receipt of the withdrawal, via the original payment method (Stripe → original card / bank).
  • Pro-rata payment: if performance began with the Consumer's consent under §1837(l) and the Consumer still withdraws within the 14-day period, the Consumer pays a pro-rata portion of the price for services actually rendered until the date of withdrawal (§1834).
  • Configuration data (email templates, webhook settings) is available for export 30 days after termination; thereafter permanently deleted.
  • Anonymous metrics are deleted after the standard 90-day retention.

Out-of-court dispute resolution

For consumer disputes contact the Czech Trade Inspection:

EU consumers may also use the European Commission ODR platform: ec.europa.eu/consumers/odr.

Version 1.0 · Effective: May 23, 2026

Document hash (SHA-256): bac003d9738cc6cace86d70872a4108d7be3292a620fda88d119eb6afa63aecc

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