Description – Reference:

Name SURNAME:

Email Address:

Address:

Post Code:

City:

Country:

Custumer Number:

Date of purchase:

Order Number:

Invoice Number:

Goods received on:

Date of Withdrawal:

Comment on your withdrawal:

In accordance with legal provisions (article L.221-18 and following of the French Consumer Code), please refund my payment (in XPF)

representing the total amount of my order here above mentioned, as soon as you receive the jewel (s) returned on

by registered mail, at my own expense, to the following address:

SARL PERLE MON AMOUR
B.P. 21286
98713 PAPEETE – TAHITI
Polynésie Française
Email: perlemonamour@mail.pf
Phone: +68987770232