Cancellation Form

To: FirstPoint International Limited (company number: 10043018), trading as FirstPoint USA, Cardinal House, 6th Floor, 20 St Mary’s Parsonage, Manchester, M3 2LG (“Company”) or send electronically to info@firstpointusa.com.

I, [                    ] hereby give notice that I, [                            ] cancel my contract with the Company dated [                        ] for the supply of consultancy/representation services.

Name of individual:

Address of individual:

Signature of individual (only if this form is notified on paper):

Date: