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9 LASERSYSTEM INSTALLATIONRECORD

(to be fled in by 2quafied distrbutor's service technician perform ng instalation)

SYSTEM TYPE:

SYSTEM SERIAL NUMBER: 821001S


DISTRIBUTOR:
PERSON RESPONSIBLE FOR INSTALLATION:

DATE OF INSTALLATION:

PLACE OF INSTALLATION (exact address):

Distributor

Full name of responsible person:

Signatureand stamp: Gabriel Mei

Please fill in this record in details and stamp it. Acopy of this record needs tobe sent,latest 14 days
after date of installation, to a producer of this laser system for a warranty to become effective.

Please use one of below contact details for sending a copy of this record:

Fax: + 386 1 620 46 01


E-mail: optotek@optotek.si

Person performing the installation of the system must also fill in the attached Installation,
Annualcheck and Service Check Test Report OB1091-17 and send it back to Optotek
(optotek@optotek.si).

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