Olsberg Konigshutte Lima Instructions page 67

Information of the appliance owner:
Name: ........................................................................................................................................................................
Address: ....................................................................................................................................................................
Telephone: .................................................................. Cell phone: ............................................................................
Information of the specialised company:
Name: ........................................................................................................................................................................
Address: ....................................................................................................................................................................
Telephone: .................................................................. Cell phone: ............................................................................
Employee title (person responsible for commissioning): ...........................................................................................
Appliance designation: ............................................... Model no.: .............................................................................
Serial no.: ................................................................... Purchase date: ......................................................................
Chimney calculation present: yes no
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: ...................................................................................................................................................................
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