Appendix A

Revocation Form

(If you are a Consumer and wish to revoke the contract, please complete and return this form)

To:

Wattify BV

Kriephoekstraat 25

9230 Wetteren, Belgium

e-mail: info@wattify.be

Contact form: https://wattify.be/nl/boek-demo#contacteerons

I hereby revoke the contract I entered into for the Charging process indicated below at a Charging Station operated

operated by Wattify BV, including the purchase of the electricity I have charged.

Charging Process from (date):

Charging Station details (address and EVSE ID, if available):

Email address you provided at the time of contract conclusion:

Date

Signature (only if submitted in hard copy)