Heidolph Hei-VAP Value - Declaration of Non-Objection

Appendix
Hei-VAP Value, Hei-VAP Advantage 75
EN
12.6 Declaration of non-objection
Copy and mail / fax this declaration in the event of repairs to Heidolph Instruments GmbH & Co KG (see Chapter
9.4).
1. Information regarding the
unit
Model description
Part number
Reason for submission
2. Was the device cleaned, if
necessary, decontaminated
/ disinfected?
Yes
No
3. Is the unit in a condition
that poses no health risks
to repair personnel?
Yes
No
If no, what substances was the unit
in contact?
4. Information regarding the
sender
Last name, first name
Company
Department
Street
Postal code / city
Country
Telephone
E-mail
5. Legally binding declaration
The client is aware that he is liable
to the contractor for damages
caused by incomplete and incorrect
information.
Date
Signature