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MATERIAL RETURN FORM

Nature of Complaint*:

Module Type :

Module Name :

P.O. No.* :

Date* :

(mm/dd/yyyy)

Repair during Warranty Period

Original Invoice No.* :

Date of receipt of material* :

(mm/dd/yyyy)

Repair after expiry of Warranty Period

Repair charges will be paid by the person sending the item for repairs

Repair charges will be intimated and agreed-upon before undertaking the repairs

Transport Details

Transport Agency :

Bill No. :

Essential documents to be enclosed/sent :

Address for returning the repaired item

Company :

Address :

City/State :

Country :

Phone* :

Fax :

Attention :

Ref. No. :

Product Details

Product Family :

Module Serial No. :

Board Serial No. :

Software Version :

Fault

In which configuration has the fault occured :

Symptoms :

Constant

Periodic

Nature* :

Reported alarm on above fault :

Brief Description of Fault :

Your Name* :

Your Phone* :

Your Fax :

Notes
	Use dust cover when returning optical modules and antistatic bag with proper packing.
	Take neccessary ESD precautions while handling & packing of modules and pack the modules in safe packing.
	A certificate on the following lines needs to be sent alongwith the material: "Certified that the article mentioned above is already duty paid, but due to passage of time the relevant invoice/gate pass bearing evidence of payment of duty is not available. The article mentioned above is non polluting, non inflammatory and non hazardous in nature."