COMPLAINT FORM
made on
_
in connection with complaint no.
_
SUBJECT OF COMPLAINT
BOILER TYPE:
Date of boiler production:_
Boiler serial number:
Date of boiler purchase:
CLAIMANT
Name and surname
_
Detailed address
_
Phone no.
_
DETAILED DESCRIPTION OF
QUALITY FAULTS OR FAULTS RESULTING FROM THE MANUFACTURER’S FAULT
OTHER FAULTS
_
CLAIMANT LODGES WARRANTY CLAIM FOR (SELECT APPROPRIATE):
Warranty repair
Paid repair
Post-warranty paid repair
CLAIMANT REQUESTS
_
In case of
unjustified calling the service, the CLAIMANT agrees to cover the costs incurred by the manufacturer’s
service.
(city, date)
(sign of claimant)
(signature of serviceman)
REMOVAL OF BOILER’S FAULT
-
to be filled by service
Date of informing the service technician about fault
hour
Name and surname of service technician
Way of fault removal
Advice (DESCRIPTION)
_
END OF COMPLAINT
Name and surname of service technician
Fault removal date
Justness of complaint
_
Duration of repair
Fault (defect) has been removed, the boiler operates correctly. I hereby confirm the removal of the fault. I declare that I have familiarised myself with the conditions of
warranty on the basis of which I wish to register my complaint and I agree for processing my personal data for complaint register purposes according to art. 6 section 1
letter a of the general regulation on personal data protection of 27 April 2016 (OJ EU L 119 of 04.05.2016).
(city, date)
(sign of claimant)
(sign of person registering complaint)
NOTE! In case of the
unjustified calling of the “DEFRO” service the CLAIMANT covers the labour costs and travel expenses*
*cost per man-hour and travelling expenses are calculated according to the current price list available at www.defro.pl.
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