Claim Form

Sample Claim Form

SPESAR Sp. z o.o. sp.k.
ul. Szczepankowo 146D/2
61-313 Poznań
POLAND
natibaby@natibaby.com
NIP 7822759252

Name and surname:...................................................................................................................

Street: .................................................................................................................................

Zip code: .................................................

City: ...................................................

Telephone: ......................................................

Email:..............................................................

Description of goods (e.g. type, model - symbol): .........................................................……………….

Order number: ....................................................

Order Date / date of contract of sale conclusion: ...................................................

Number of VAT invoice / receipt and date of issue (optional) or other proof of purchase .......................................

...............................................................................

Description of the defect: ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ ................................................................................................................................................................... ...................................................................................................................................................................

Date when the defect was recognized: .......................................................................................

.....................................................

    Date and Customer(s) Signature(s)s