MODEL WITHDRAWAL FORM

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

You do not have to use this form. You can also use the button "Withdraw from
the contract here" in your account settings or at the bottom of memoto.nl, or
simply send us an email.

-- To: Octadex (Memoto), De Tilbarten 49, 9084 CB Goutum, the Netherlands,
   email hallo@memoto.nl:

-- 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 on (*)

   ............................................................

-- Name of consumer(s)

   ............................................................

-- Address of consumer(s)

   ............................................................

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

   ............................................................

-- Date

   ............................................................

(*) Delete as appropriate.

Octadex, trading as Memoto - CoC 99648156 - VAT NL005402523B71
Phone +31 6 39 56 99 33 - hallo@memoto.nl - memoto.nl