Declaration Letter

Date: 22/12/2016

To,
The Branch Service Manager,
Samsung India Electronics Pvt. Ltd,

-----------------------------------------

Dear Sir,
I Mr
S/O
Hereby request you that please give Refund against my product bearing.
Model No UA49K5570AUMXL
Serial No.
in the name of
in case of refund -

Bank Name: ICICI BANK.

Bank Account No.
Payable at:
Cancelled cheque No. :

I hereby declare that

- There would be no change in name or cancellation of cheque henceforth
- Agree for depreciation as per company policy if product out of warranty
- I will return the product (with above details) to SIEL at the time of receiving
Replacement set / refund cheque.

Thanking You,
Customer name/Sign with Address