29
18.
COMPLAINT FORM
COMPLAINT FORM
made on
......................................................
in connection with a complaint no.
.......................
SUBJECT OF COMPLAINT
EQUIPMENT TYPE:
...........................................
Equipment manufacturing date: ............................................
Equipment serial no.:
...........................................
Equipment purchase date:
............................................
CLAIMANT
Name and surname:
............................................................................................................................................................
Detailed address:
............................................................................................................................................................
............................................................................................................................................................
Phone number
............................................................................................................................................................
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 when a claim is not taken into consideration because circumstances, mentioned in p. 17 and 18 of the Warranty Terms are discovered, the
CLAIMANT agrees to cover the costs incurred by the manufacturer’s service.
....................................................................
....................................................................
...................................................................
(city and data)
(a sign of claimant)
(signature of serviceman)
FAULT REMOVAL - 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:
...........................................
Failure removal date:
............................................
service technician:
...........................................
Repair duration:
............................................
Fault (defect) has been removed, the equipment operates correctly. I hereby confirm removal of the fault. I declare that I have familiarised myself with conditions of war-
ranty 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 the Data Protection
Act of 29 August 1997 (Journal of Laws No. 133 item 833).
....................................................................
....................................................................
...................................................................
(city and data)
(sign of claimant)
(signature of serviceman)
ATTENTION! In case when claim is not taken into consideration because circumstances, mentioned in p. 17 and 18 of the Warranty Terms are discovered, the CLAIMANT agrees to cover the costs incurred by the manufac-
turer’s service.
**cost per man-hour and travelling expenses are calculated according to the current price list available at www.defro.pl.
