Addendum to agreement on Product Verification (MID module F)

The Products listed below has been modified according to its TEC and all placed on the same site/ tank truck/ gantry.
By returning this form, we extent the agreement on Product Verification to include the Products listed in this form.

Doms Metrology ApS is hereby requested to perform Product Verification (MID module F) on the Products according to the agreement:

Modified MID Product
MID certificate
(TEC)
Serial
number
Forcourt/
Truck
number
Date of last Verification

Owner, Place of installation etc.
Name of owner *   Adress *
OBS ! Place of installation/ installationsadresse
Postal code / Postnummer *   City / By *

Orderer, reference to contract
Orderer = Manufacturer *   Product Verification Contract *
Date of request Name of person requesting /
udfyldt af *
Return e-mail / E-postadresse *
For these Measuring Systems, the manufacturer/
Producenten *

pays/betaler

Does not pay / betaler ikke
6 + 3 - 2 = ?
input answer / indtast resultatet *


Upon reciept of the form, Doms Metrology ApS shall contact the dispatching person in order to have the form verified / Efter modtagelse foretages kontrol.

Please fill in all entries marked with * / Venligst udfyld alle felter med *.



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