F-13-01
Page
2 / 4
Version
01
Effective Date
01.01.2008
C. Legally binding declaration
I (we) certify that all information given in this form is correct and complete.
The equipment and components have been adequately decontaminated and cleaned according to the legal requirements.
No chemical or biological or radioisotopic risks remain that can endanger exposed persons' safety or health.
Company / Institute
Address / Country
Tel. / Fax (with area code)
Name of the authorized person
Position
Signature / Date
D. Reason for return
wrong delivery
E. Please describe the problem(s) or fault(s) you have found (for repair) and/or indicate the remedial
actions you require
Return of material
exchange
repair
modification
disposal
other