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Verfügbare Sprachen
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!
1.
Information on the device
Item number:
Serial number:
Reason for submission:
Does this product pose a risk to people and/or the environment due to
its use for processing substances that are hazardous to health, the envi-
2.
ronment and/or biohazardous? Please mark with a cross and complete
the information!
NO
YES
3.
Information on the client/sender:
Name, first name:
Company/institution:
Department/working
group:
Address:
Zip code, city:
Country:
Phone:
E-Mail:
4.
Legally binding declaration
With his signature, the client/submitter declares the completeness and correct-
ness of his details. Missing or incorrect information obligates to compensation for
damages.
Date
If YES, with which substances did the device come
into contact?
If NO, what cleaning and/or decontamination
measures were carried out?
Signature, company stamp
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