MK (E2.1) 10/2014
page 73/73
4.
Declaration of Decontamination
For toxic, radioactive, biologically and chemically harmful or hazardous substances, or any other
hazardous materials
.
We hereby guarantee that
4.1 Any hazardous substances, which have come into contact with the above-mentioned equipment /
component part, have been completely listed under item 3.1 and that all information in this regard is
complete
.
4.2 That the unit /component part has not been in contact with radioactivity
4.3 Any Hazardous substances were removed from the unit / component part, so that no hazard exists
for a persons in the shipping, handling or repair of these returned unit
4.4 The unit was securely packaged in the original undamaged packaging and properly identified on the
outside of the packaging material with the unit designation, the RMA number and a copy of this dec-
laration.
4.5 Shipping laws and regulations have not been violated.
I hereby commit and guarantee that we will indemnify BINDER Inc. for all damages that are a con-
sequence of incomplete or incorrect information provided by us, and that we will indemnify and
hold harmless BINDER Inc. from eventual damage claims by third parties.
Name:
_______________________________________________________________________
Position:
_______________________________________________________________________
Company:
_______________________________________________________________________
Address:
_______________________________________________________________________
Phone #:
_______________________________________________________________________
Email:
_______________________________________________________________________
Date:
_______________________________________________________________________
Signature: _______________________________________________________________________
Equipment returned to the NY warehouse for repair must be accompanied by a completed
customer decontamination declaration. For service and maintenance works on site, such a
customer decontamination declaration must be submitted to the service technician before the
start of work. No repair or maintenance of the equipment is possible without a completed form.
