Registration form product surveillance
- 52 - V07 en, Basic_Installation_Accessories
Reg.No.
To Service
Email: psu@RATIONAL-online.com
(to be filled in by Service in Landsberg)
Registration form for product surveillance
From subsidiary/
dealer:
Reported by, Name:
P = injury to a person (Please fill in letter)
G = danger to a person
S = property damage with danger to a person
V = insurance case
P+S = accident with injury to a person and property damage
*with an insurance case,
include insurance form and add ”V” above
Where installed (address): Installed by:
Combi-Steamer/Accessories
(Type, Serial no, other markings)
Date/time when fault occurred:
Installation date: Date fault settled:
Description of fault: (if nec. diagrams, surrounding conditions, installation room, photos, in the case of
serious injury please provide info in advance to tel.
+49 8191/ 327 208)
Other remarks: (measures carried out or arranged; whereabouts of appliance/parts; info to specialist dealer,
chimney sweep, end-user etc.; informed authority, expert, police etc.)
Report on findings required? yes / no
If you exchanged service parts, pls return to RATIONAL
Landsberg, QM-R, as soon as possible!
Include a copy of this registration form!
Sent out (date):
Which parcel service:
Parcel number / Tracking number:
Please email Rational subsidiary direct!!!
US/CA
Ship any parts direct to Rational US or Canadian office..
US/Canada 12/2018
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