CANCELLATION FORM

COMPLETE AND RETURN THIS FORM ONLY IF YOU WISH TO CANCEL YOUR ORDER

To: help@dice.fm or DICE FM Limited, 62 Shoreditch High Street, London E1 6JJ.

[*] Delete as appropriate:

I/We* hereby give notice that I/We* cancel my/our* contract of sale of the following goods*:

Order number:

Ordered on/received on*:

Name of consumer(s):

Address of consumer(s):

Signature of consumer(s) (only if this form is sent by mail):

Date: