Hello {customer_name},

We confirm receipt of your withdrawal declaration.

Received:
{submitted_at}

Order number / order reference:
{order_reference}

Withdrawal concerns:
{scope_label}

Affected items / quantities:
{withdrawal_items_text}

Your message / note:
{message}

This message only confirms receipt of your withdrawal declaration. Further processing and review will follow separately.

Kind regards
{shop_name}