Model Consumer Withdrawal Form

Form version: October 11, 2026

Use this form only if you wish to withdraw under an applicable consumer right. You may instead send any clear statement of withdrawal. See Terms, Section 8.

To: Cryptify Corporation, Delaware file number 10430008, 8 The Green, STE R, Dover, DE 19901, USA, +1 323 554 8150, [email protected]

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

Service / subscription: ____________________

Ordered on: ____________________

Consumer name(s): ____________________

Consumer address(es): ____________________

Account email or order reference (optional, helps locate the purchase): ____________________

Signature of consumer(s), only if this form is submitted on paper: ____________________

Date: ____________________

Delete as appropriate. No reason for withdrawal is required. This form does not replace ordinary cancellation of future subscription renewals, which is available through Billing or [email protected].