WARRANTY CLAIM DECLARATION FORM

* Place: * Date:

WARRANTY CLAIM DECLARATION FORM

CLAIMANT

1. Name and surname:*
2. Company name:*
3. Address:*
4. Tel. no.:*
5. E-mail:*
6. NIP (Taxpayer Identification Number):*

SPECIFICATION OF THE VEHICLE SUBJECT TO WARRANTY CLAIM

1. Vehicle type:*
2. VIN:*
3. Registration No.:*
4. Date of first registration:*
5. Documentation No. of the warranty information booklet:

DESCRIPTION OF DEFECT/DAMAGE

Exact description:

ATTACHMENTS

ATTENTION: Attachment of the following to the „warranty claim declaration form” is required: a scan of the vehicle registration book, scan of invoices of all conducted warranty inspections, photographic documentation (of the damaged/faulty vehicle element, as well as photographs of the entire vehicle form all sides and inside, including the VIN, in low resolution).
In the case where the required fields are not filled out and there is a lack of the attachments specified above, the warranty claim will be rejected.
Each vehicle/element subject to the warranty claim must be exactly cleaned before its delivery to the Guarantor/Service. If not, the claimant will be charged with the costs of the vehicle(s)/element(s) subject to the warranty claim.
* - required field, to be filled out

The claimant – owner of the purchased product has been informed of the deadline for consideration of warranty claims according to the general warranty conditions found in the warranty information booklet.

* Yes, I have read the above terms and conditions claim.

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WARRANTY CLAIM DECLARATION FORM