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DATUM
DATE
INBOUWSTATION
INSTALLATEUR
A/c NO.
INSTALATIE CERTIFICAAT
CERTIFICAT D’INSTALLATION
Ik , ondergetekende, professioneel installateur, verklaart hierbij dat de installatie van het
alarmsysteem zoals hieronder beschreven door mij is uitgevoerd volgens de montage instructie
welke door de fabrikant van het systeem is aangeleverd.
Je soussigné, installateur, certifie avoir fait personnellement l'installation du dispositif d'alarme du
véhicule ci-décrit, conformément aux instructions du constructeur.
GEVEGENS VAN DE EIGENAAR
RENSEIGNEMENTS DU CLIENT / PROPRIETAIRE DU VÉHICULE
NAAM /
NAME
ACHTERNAAM /
SURNAME
ADRES /
ADDRESS
TEL. NO.
POSTCODE /
POSTCODE
GEVEGENS VAN DE AUTO
RENSEIGNEMENTS DU VÉHICULE
MERK /
MARQUE
MODEL /
MODÈLE
CHASSIS NO.
KENTEKEN /
REG. NO.
JAARLIJKSE CONTROLE
VERIFICATIONS ANNUELLES DU SYSTÈME
DATUM
DATE
INBOUWSTATION
INSTALLATEUR
DATUM
DATE
INBOUWSTATION
INSTALLATEUR
A/c NO.
A/c NO.
PRODUCT BESCHRIJVING
DESCRIPTION DU PRODUIT
MERK /
MARQUE
GOEDKEURINGSNUMMER /
NUMERO D'HOMOLOGATION
TYPE /
TYPE
HANDTEKENING
/
SIGNATURE
DATUM
DATE
ADRES /
ADRESSE
INBOUWSTATION /
INSTALLATEUR
POSTCODE /
CODEPOSTAL
TEL. NO.
DATUM VAN INSTALLATIE
DATE DIINSTALLATION
INSTALLATIE DETAILS
RENSEIGNEMENTS DE L'INSTALLATION
A/c NO.
22


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