人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人人��ࡱ� > �� r t ���� q �������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������� c� �� � bjbjZ�Z� 8J 8�b\8�b\1 � �� �� �� � � � V V V V V ���� j j j 8 � D � � j �- � z p � ( F F F 9- ;- ;- ;- ;- ;- ;- $ d/ � 2 � _- V F F F F F _- V V 4 t- @$ @$ @$ F F V V 9- @$ F 9- @$ @$ : * � �* ���� ������ ���� � � �* %- �- 0 �- �* . �2 ! � �2 �* �* �2 V + F F @$ F F F F F _- _- �! t F F F �- F F F F ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� ���� �2 F F F F F F F F F � > : Instruction Computer must be used to fill out this form, handwriting is not accepted. Products are only permitted to be returned to Flexicon after this decontamination form has been filled in, signed by the customer, sent by mail to HYPERLINK "mailto:service.flexicon@wmftg.com" service.flexicon@wmftg.com and a subsequent RGA or RMA document with a unique number has been provided by the Flexicon service department. A Return Goods Authorization (RGA) is issued for products to be returned to Flexicon for repair, testing or preventive maintenance. A Return Materials Authorization (RMA) is issued for products to be returned to the Flexicon ware house and a credit note is assumed to be sent to the sales company. Once the RGA or RMA document has been issued, it must be attached onto the outside of the packaging prior to shipment to Flexicon. The purpose of this procedure is to protect our employees against contact with remains of hazardous substances, which potentially could be on the surfaces of returned products. If this procedure is not followed the delivery of the package cannot be accepted and will be returned. For further information please contact us at HYPERLINK "mailto:service.flexicon@wmftg.com" service.flexicon@wmftg.com or call (+45) 8887 1740 Contact information NameAddressContact personPhone / E-mailSales companyCustomer Fault description Product name:Part code and serial number:Contact person at Flexicon (If any):Fault description in English language (As accurate as possible please): Return shipment Return shipment:Normal FORMCHECKBOX Express FORMCHECKBOX Return address: Decontamination As described in the European Union REACH legislation and the corresponding Danish laws you, the user, are required to declare the substances which have been in contact with the items(s) you are returning to Flexicon. If the item(s) received has not been cleaned and/or if the description of the products in which the item(s) has been in contact is not described in details Flexicon can return the item(s) un-opened at your cost. Has the item(s) been used?Yes FORMCHECKBOX (Continue to fill out the following)No FORMCHECKBOX Description in English language of the products/liquids being used with the item(s) returned. (A Material Safety Data Sheet (MSDS) in English language can be provided as an attachment to this form): Description in English language of the necessary precautions to be taken in handling these products/liquids: Description in English language of actions in case of human contact with the products/liquids used with the returned item(s): FORMCHECKBOX I hereby confirm that the only substances(s) that the equipment/items specified has pumped or come into contact with are those named, that the information given is correct, and the carrier has been informed if the consignment is of a hazardous nature. FORMCHECKBOX I also confirm that the item(s) returned are cleaned and free from any remains of products/liquids.Name: Position: Date and signature: Decontamination form for products to be returned to FlexiconRev.: 06Date: 2016-10-18Page PAGE 1 of NUMPAGES 2 I L Y b x � � � � 7 8 9 < = > I ] r � � . A B Z ` � � � � � � � � ��������ɨ�����xɿɿ��n���n��d��n h�i? aJ mH sH h�dU aJ mH sH h�": h�6% aJ mH sH hp hp 0J mH nH sH u$hp hp B* mH nH phI} sH u -j hp hp B* UmH nH phI} sH uhOa� aJ mH sH h�6% aJ mH sH h7G� h7G� 5�aJ mH sH h7G� aJ mH sH h�_� aJ mH sH h8� h�[ mH sH &