Capenergy C 50 User Manual page 75

CERTIFICATE OF DELIVERY AND INSTALLATION
The undersigned _______________________________________, has been qualified and
entitled to act in name and respresentation of the company Capenergy Medical, S.L, with VAT B-
62171731, and central offices in Sant Joan Despí (Barcelona), Avda. Mare de Déu de
Montserrat, 41, for the emission of the certificate of installation for the following device:
Model ________________ Serial number __________ Date of production ___________
And DECLARES
Having verified all standard accessories and they are in a correct state.
Having installed the device according to the manufacturer's instructions.
Having received the user manual in the ________________ language.
Having instructed all personnel responsible for using the device.
Having verified the total absence of defects and the correct functioning of the device.
Having verified the correct functionality of the safety control.
Having verified that the user does not have any reservation or objection regarding the
delivered good and that he therefore accepts it unconditionally.
The operations have been performed in presence of ____________________________,
employee selected
_______________________________
______________________________________________Email: ____________________
as the person responsible for the use of the device.
The present declaration is issued for the agreed upon use and according to the approved laws.
Date,___ of ____________,
.........................................
1 Three (3) copies of this certificate are issued:one for the client, one for the distributor and a third one has to be filled in and sent
to the manufacturer CAPENERGY MÉDICAL,S.L. within 7 days after the installation of the device.
REG.7.2-01-01
by medical center______________________located
at
The installation
tecnic
............................
User Manual
Page 75 of 95
the following
Stamp and signature
.........................
in
address
The client