Warranty

Date of Application (DD/MM/YYYY): ______/______/______

Personal Details:

First Name: ______________________ Middle Name (s): _________________________

Surname: ______________________

Address: _______________________________________ Nationality: ____________________

Town/Suburb: _____________________ State: _____________________ Postcode: ______________

Nation: ______________________ Signature: ______________________________________

Home Phone ( ) Mobile: ( ) Email: _________________________

This insurance is only applicable if:

Damage on the appliance was entirely accidental. The consumer has fallen over and thus, the brace is
damaged.
A reasonable period of time from the date of delivery until failure is apparent.
Defects of the equipment are present when or after the customer takes the delivery.
The customer must carry-in or mail-in the damaged item for a lab analysis of tampering to fake damages.
Lab analysis shows that the product was taken care of and not exposed to unnecessary elements during
use.
Brace Details:

Brace Size (Small, Medium or Large): __________ Serial Number: __ __ __ __ -- __ __ __ __ -- __ __ __ __ -- __

Date of Purchase (DD/MM/YYYY): ______/______/______ Date Received (on receipt) (DD/MM/YYYY): ______/______/______

Product Issue (if any): _____________________________________________________________________________________

Other inquiries (if any): ____________________________________________________________________________________