UBC BEST Operating And Maintenance Manual page 26

Goods accepted for warranty service
(Name of the company-manufacturer, which performs warranty service, legal address)
Date of warranty claim
The number under which the device is taken for warranty
(Surname, first name, patronymic of the responsible person of the Executant)
Stamp here
Accounting for maintenance and warranty repair work
Malfunction
Date
description
Warranty period is extended
until
until
(Surname, first name, patronymic of the responsible person of the Executant)
Stamp here
The device is discounted
New price
(Surname, first name, patronymic of the responsible person of the Executant)
Stamp here
The back of the Warranty Certificate
Filled by the Executant
(Year, month, date)
Works performed, name and type of
replaced parts and assemblies
20 until__________20___
20 until__________20___
(Date and number of the device discount act)
(Amount in words)
25
(Signature)
Executant's
signature
(Signature)
rubles
(Signature)