Withdrawal of Student Membership
The undersigned hereby withdraws the direct debit authorisation granted Leiden University Fund from the account mentioned below for the following reason
After canceling my LUF Student Membership, I no longer use the LUF discount pass
Date of birth
Yes, I hereby declare that I have completed the form above truthfully.
Yes, I will send my LUF-card to Leids Universiteits Fonds, Antwoordnummer 10318, 2300 WB Leiden.
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