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I hereby wish to (partially) terminate the agreement of:
Child's name (first and last name):
*
Debtor number:
*
Location:
*
It concerns a:
Full cancellation
Partial cancellation (tick the day(s) below)
I wish to terminate the following day(s):
Monday
Tuesday
Wednesday
Thursday
Friday
Reason for termination:
*
Comments:
Date of (partial) cancellation:
*
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