WithdrawalWithdrawal formComplete and submit this form only if you wish to withdraw from your contract.Table of Contents ToggleWithdrawal formTo:Required fields are marked with an asterisk (*).To:Paltu Kumar Das Vill.- Patna, p.o- Ajaya, P.S - Khejuri, Purba Medinipur, 721430 Name * Email address * Goods or service being withdrawn * Address Order or contract reference Order date Additional message Leave this field empty Send withdrawal request