City (location) of the product acceptance __________________________________________
Name
of
_____________________________________
___________________________________________________________________________
Address and delivery information _______________________________________________
"_____"_____________201___
The present certificate has been made ____________________________________________
together with the representatives of ______________________________________________
___________________________________________________________________________
or representative of company concerned, date and number of the document certifying
authorities of representatives for participation in inspection)
(Telegram requesting for the manufacturer representative
No. ___ dated "___"______201___)
to certify that during inspection of the product
___________________________________________________________________________
manufactured by _____________________________________________________________
product factory number ________________ the following has been detected:
1.
Product storage conditions at the recipient warehouse:
___________________________________________________________________________
1.
Condition of container and package
___________________________________________________________________________
(specify condition of external marking, date of container unpack, number of missing parts, their
1.
The product is installed
___________________________________________________________________________
1.
Product assembly
___________________________________________________________________________
(specify who and when assembled the product, assembly quality)
1.
Product condition and complete set of supply
___________________________________________________________________________
(specify technical condition of product, electrical equipment, condition of their protection,
1.
List of deficiencies (defects):
___________________________________________________________________________
Attachment B
the
product
CERTIFICATE OF TECHNICAL CONDITION
(recipient representative, last name, title)
(last name and title of manufacturer representative)
(product name)
(name and address of manufacturer)
(specify product storage conditions)
cost, defects of container and package)
(specify conditions of product installation)
factory numbers, date of manufacturing)
(sample)
recipient
(company,
facility)
3