51
Annex
Declaration of no objection
Enclose the declaration of no objection, duly completed, with your device return.
Submissions without a declaration of no objection cannot be processed!
Yes
No
(Please mark as applicable)
Yes
No
(Please mark as applicable)
Has the device been cleaned, decontaminated/disinfected?
If yes, which measures were carried out?
Does this device pose a risk to people and/or the environment due
to the processing of substances that are hazardous to health,
the environment and/or are biohazardous?
If yes, with which substances did the device come into contact?
LEGALLY BINDING DECLARATION
The principal/consignor is aware that they are liable to the agent/consignee for losses or damage incurred due to incomplete and
incorrect information.
Date
Signature
Company stamp
Please fill in the required fields.
Note: The sender must package the goods
properly and appropriately for transport.
DECL ARATION OF
NO OBJEC TION
IN C A SE OF RE T URNS
SENDER
Name
Company/institution
Address
ZC/City
Country
First name
Department
Workgroup
Phone
Heidolph Instruments GmbH & Co. KG
Walpersdorfer Straße 12
91126 Schwabach, Germany
Phone: +49 (0) 9122 9920-380
Fax: +49 (0) 9122 9920-19
Email: [email protected]
DEVICE DETAILS
Article number
Reason for sending in
Serial no.
Ticket number
© Heidolph Instruments GmbH & Co. KG
Doc-ID: 01-006-003-30-0 – Ed.: 2022-07-28
