Form of Return

Standard form for exercising the right of claim:

To: MILOTKA LTD. with UIC 206293003

I/We hereby inform you that I/we have found a discrepancy between the product(s)
received and the agreed in the sales contract.

Subject of the claim:

Ordered on / received on: …………………………………

Preferred way of satisfaction of the claim (circle the desired option):

Refund of the amount paid

Replacement of the goods with another that corresponds to the agreed

I enclose the bill of lading received from the supplier.

Amount of the amount claimed: …………………………………………………………………

User’s signature (only when submitting the document on paper):

Date

Milotka