RETURNS FORM Europharma Ltd Catalunya Buildings, Psaila Street, Birkirkara, BKR 9076, Malta Tel: (+356) 23 859 2 11 Email: info@europharma.com.mt Complete and return this form if you wish to withdraw from the contract of the purchase. Terms and conditions governing returns as specified on our website refer I/We hereby give notice that I/We withdraw from my/our contract of sale of the following goods. Name of Customer: Address of Customer: ORDER Number: Ordered on: Received on: Contact no: INVOICE Number: Email: Item Code Item Description Quantity Returned Return Code Comments Reason for return: Date: Customer Signature: