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Watson-Marlow 620DuN and 620Du User Manual 112
Your name
Company
Address
Postcode/zip Country
Telephone Fax
Product type Serial number
To speed the
repair, please
describe all
known faults
The product has ...
■■ Been used ■■ Not been used
If the product has been used, please complete all the following sections.
If the product has not been used, please just sign this form.
Names of
chemicals handled
with product(s)
Precautions to be
taken in handling
these chemicals
Action to be taken
in the event of
human contact
I understand that the personal data collected will be kept confidentially
in accordance with the UK Data Protection Act 1998.
RGA number
Signature Your position
Date
Please print out, sign and fax to Watson-Marlow Pumps at +44 1326 376009.
DuN, Du 39 Decontamination certificate
In compliance with the UK Health and Safety at Work Act and the Control of
Substances Hazardous to Health Regulations, you are required to declare the sub-
stances which have been in contact with product(s) you return to Watson-Marlow or
its subsidiaries or distributors. Failure to do so will cause delays. Please ensure that
you fax us this form and receive an RGA (Returned Goods Authorisation) before you
despatch the product(s). A copy of this form must be attached to the outside of the
packaging containing the product(s). Please complete a separate decontamination
certificate for each product. You are responsible for cleaning and decontaminating
the product(s) before return.