Warranty Application
| Operation Manual C 2213 |
39
15 Declaration of harmlessness
Declaration of Harmlessness
Please fill out a separate form for each appliance!
We forward the following device for repairs:
Device and device type: ..............................................................................................................
Part-no.: .....................................................................................................................................
Order No.:.................................................................. Date of delivery:........................................
Reason for repair: .......................................................................................................................
...................................................................................................................................................
Dosing medium
Description: .........................................................
Irritating:
Yes
No
Properties: ...........................................................
Corrosive:
Yes
No
We hereby certify, that the product has been cleaned thoroughly inside and outside before
returning, that it is free from hazardous material (i.e. chemical, biological, toxic, flammable, and
radioactive material) and that the lubricant has been drained.
If the manufacturer finds it necessary to carry out further cleaning work, we accept the charge
will be made to us.
We assure that the aforementioned information is correct and complete and that the unit is
dispatched according to the legal requirements.
Company / address:.............................................
Phone: .....................................................
............................................................................
Fax:..........................................................
............................................................................
Email: ......................................................
Customer No.:......................................................
Contact person: ...................................................
...................................
..............................................
Date
Signature
