LMC
delivery
report
On the date of transfer,
please complete this form
and return to LMC.
Confirmation:
I confirm that I have today
received the service log relating
to the five-year guarantee for
leak-tightness for the vehicle
specified.
I have read the conditions
relating to the leak-tightness
guarantee and herewith con-
firm my agreement to these
terms.
Date
Signature of customer
Customer address:
Last name, first name:
Profession:
Street, number:
Postal code, town:
Country:
Vehicle data:
Model:
Type:
Key no.:
Vehicle chassis number:
Serial no.:
Date of first registration/date of transfer:
Expiry date of guarantee priod:
Dealer data:
Dealer no.:
Stamp and signature of LMC dealer
