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TO BE COMPLETED BY THE CONTRACTOR
Performer
________________________________________________________________
name of enterprise, organization, address
Reason for repair.
Name of the replaced component, component:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Date of repair: ____________________________________________________________________
(Number, month, year)
______________________________________________________
__________________________
(surname, name, patronymic of the responsible person-executor)
(signature)
РР
Signature of the Consumer,
confirming the performance of works
______________
______________
on warranty repair
(signature)
(date)
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