Declaration of no objection
When sending in for repair, please copy this form, fill in and send along with each device!
Declaration of No Objection - Form
(please fill in one form for each device and attach it to the outside of the device)
We are returning the following device for repair:
Device and device type: .............................................................................................................
Part No.: ...................................................................................................................................
Order No.: ................................................................................................................................
Date of delivery: ........................................................................................................................
Reason for repair: .....................................................................................................................
Medium conveyed
Description: ...............................................................................................................................
Properties: .................................................................................................................................
Irritant:
Yes/No*)
Corrosive:
Yes/No*)
*) Please delete as appropriate!
We hereby certify that the product has been cleaned thoroughly on the inside and outside before
shipment, that it is free from hazardous chemical, biological, or radioactive substances and that the oil
has been drained. *)
If the manufacturer finds it necessary to carry out further cleaning work, we will accept the related
costs.
We confirm that the above statements are correct and complete and that the device is being shipped
according to legal requirements.
Company: ..................................................................................................................................
Address: ....................................................................................................................................
.................................................................................................................................................
.................................................................................................................................................
Telephone: .................................................................................................................................
Fax: ...........................................................................................................................................
E-mail: ......................................................................................................................................
Customer No.: ...........................................................................................................................
Contact person: .........................................................................................................................
Date, signature, stamp: ..............................................................................................................
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| Operating Manual FEDOS E/DX | Declaration of no objection
