[Place and date]

Applicant

[Full name]
[Correspondence address]
[Email address or telephone number]

Recipient

[Creditor's full legal name and address]

Early repayment settlement request

Regarding agreement no. [number] dated [date]

Scope of the request

On [date], I repaid the consumer credit in full before the contractual repayment date, which was [date].

I request settlement of the early repayment and a proportionate reduction of the total cost of credit under Article 49 of the Polish Consumer Credit Act, taking into account any settlement already made.

Settlement and refund

Please provide a calculation of the refund due and return the resulting amount to the account [customer's account number], or agree another method of refund.

Article 52 of the Polish Consumer Credit Act provides for settlement within 14 days of full early repayment of the credit.

Reply and attachments

Please reply to [postal address or email address].

Attachment: [confirmation of full repayment].

[Legible signature]

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