ADP Claim Declaration

Form

Claim Type : ADP Date : 2-11-2023

Name of the Customer : Aditya Gawhale

Contact/Mobile Number : 9702262470

Service Order / Reference # : 2015205190

System Serial Number : PF31KC25

Model / Type : Legion 5

Date & Time of the loss / damage : 29-8-2021

Place of Incidence : Mumbai

Brief description of the loss / damage :

Backspace Key came off on it's own while using. Even if I try putting it back it
keeps coming off.

The laptop was sent with this defect. I didn't notice the issue earlier as I
barely used the laptop on purchase. When I found the defect I couldn't
contact customer support to send a technician as it was pandemic going on
and I had severe health issues. I'm contacting customer support now as I'm
fully vaccinated and better health wise.
Declaration:
I / We agree to provide additional information to the company, if required. I / We, the above mentioned do
hereby, to the best of my / our knowledge and belief warrant the truth of the foregoing statement in every
respect, and if l / We have made, or in any further declaration the company may require in respect of the said
loss / damage. If any of the above is false or fraudulent / any suppression or concealment of details if / when
subsequently discovered, the coverage / protection shall be void for the above mentioned unit and the
company reserves the right to recover the costs in full / part from me / us.

I have / will receive my device repaired / replaced by authorized service center.

Signature of the Customer.