F12, User Manual, V2 12.2020
MICRO SHAKE 1200
Page 24 of 25
14. SAFETY CLEARANCE CERTIFICATE
Please complete all information requests on this form prior to returning the instrument to the
manufacturer or your local distributor for servicing, repairs or return. Thank you for your co-operation.
Customer
Contact
Address
Position
Dept
Tel:
Country
Fax:
Post Code
Ref No.
Serial No.
Accessories Returned
Date of Purchase (if known)
Complaint
Has the equipment been exposed to any of the following:
(*delete as applicable)
a) Blood, body fluids, pathological specimens
*YES/NO
If YES, please specify
b) Other Biohazard
*YES/NO
If YES, Please specify
