Serial number: ...............................................
Date of commission: ......................................
Service organization:
.......................................................................
Stamp, signature
Obligatory service inspection after the 1st year of operation
Date: .............................
Obligatory service inspection after the 2nd year of operation
Date: .............................
Obligatory service inspection after the 3rd year of operation
Date: .............................
Obligatory service inspection after the 4th year of operation
Date: .............................
Obligatory service inspection after the 5th year of operation
Date: .............................
Boiler commissioning certificate
Stamp, signature of the service organization: ....................................
Stamp, signature of the service organization: ....................................
Stamp, signature of the service organization: ....................................
Stamp, signature of the service organization: ....................................
Stamp, signature of the service organization: ....................................
Data of the customer: (legibly)
Name and surname:
...........................................................................
Street: ................................................................
ZIP code, town: ..................................................
Tel.: ....................................................................