Supplier name |
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Supplier address |
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City |
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Country |
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Telephone |
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Fax |
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Email address |
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Product Name |
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Product version |
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Release date |
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I hereby state that the following tables as filled out and submitted do match our product as well as the accompanying user manual, as stated above.
Name of representation (person):
Date of signature (dd/mm/yyyy):
Signature: