Olsberg Levana Manual page 71

Commissioning Certificate
Information of the appliance owner:
Name: ........................................................................................................................................................................
Address: ....................................................................................................................................................................
Telephone: .................................................................. Cell phone: ............................................................................
Please fill out in block letters!
Information of the specialised company:
Name: ........................................................................................................................................................................
Address: ....................................................................................................................................................................
Telephone: .................................................................. Cell phone: ............................................................................
Employee title (person responsible for commissioning): ...........................................................................................
Please fill out in block letters!
Appliance designation: ............................................... Model no.: .............................................................................
Serial no.: ................................................................... Purchase date: ......................................................................
 
Chimney calculation present: yes no
(Keep the printout of the calculation together with the certificate!)
Commissioning executed on: ....................................................................................................................................
Instruction executed on: ............................................................................................................................................
Comments: ................................................................................................................................................................
...................................................................................................................................................................................
...................................................................................................................................................................................
Signature of the appliance owner after commissioning: ............................................................................................
City, date: ...................................................................................................................................................................
Signature of the specialised company after commissioning: .....................................................................................
City, date: ...................................................................................................................................................................
Send the signed Commissioning Certificate to Olsberg. Guarantee services will only be provided if a
signed Commissioning Certificate is present.
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