Form-A ME-P-007-FiiiB

Recommendation for Replacement of Unit

DOA Part NA

From: Date
Warranty Status
Warranty End Date

We have been approached by customer as per details below for the replacement of
the unit for the reasons mentioned below

Customer Name Product Details

Address Model
Serial Number
Date of Purchase
Invoice Number
Phone Number Service Edge/CMP Call ID
Repl. Stock Avail at MSC (only YES/NO
for ICP)

Reason for Recommending Replacement (Description)

Nature of Defect

Kindly Approve the replacement

Signature of Forwarding Agency (MSC/ASF/ASC)

If approved , Defective Unit Despatch Details

Dispatched on
Mode
Airway Bill No

I Certify that the defective unit is intact & no parts are removed from it
Attach Letter from customer if replacement already issued
Ref Form B of Replacement Process)

Service Manager Name

Form-B

UNDERTAKING

REPLACEMENT OF OUT OF WARRANTY PRODUCT (Camera)

To
Canon India Private Limited
_______________________
_______________________
_______________________

I / We, Mr. / Ms. / M/s ________________________ (“User / I”) had purchased a Canon ______________ bearing model no.
_________________________ and body serial number _____________________ from M/s ______________________ on
_________ vide invoice number ______________ (“Equipment”).

As there was some problem in the Equipment which cannot be rectified hence Canon India Private Limited (“CIPL”) in
accordance with their policy has replaced my Equipment with new ___________________ bearing model no.

______________ and body serial number _______________________ (“Replaced Equipment”) vide job sheet

number _______________, which is either same / equivalent model, after receipt of amount equivalent to the repair cost of
the Equipment amounting to Rs. __________.

TERMS OF REPLACEMENT

I / we undertake and confirm that the information and documents provided herein / herewith relating to the purchase of the
Equipment are true, correct and no fact has been concealed by me regarding the said Equipment.

On the surrender of the Equipment, I / We shall have no right and / or the ownership of the Equipment and CIPL is free to use
the Equipment and its parts as per its requirements.

I / we undertake to pay to CIPL the cost of the relevant parts which were required to be replaced in the said Equipments,
simultaneously upon receipt of Replaced Equipment.

I / we hereby confirm to have tested, used and checked the working, functionality, features etc of the Replaced Equipment;
and I am / we are satisfied with the same, therefore undertake not to make any claim whatsoever anytime in future in
connection therewith against CIPL or its officers, employees, directors, dealers, service dealers, etc.

I / we agree that Replaced Equipment shall carry 1 month carry in warranty with standard terms and conditions.

I / we submit myself / ourselves to the exclusive jurisdiction of courts of Delhi and further agree that CIPL’s total and
cumulative liability is limited to value of the Equipment.

I have given my consent for the replacement of the equipment on the basis of the term and conditions above.

Signature
Date:
Place: