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Certification of: _________________

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Certification of: _________________ 

Re. Steering box on:

Vehicle: ________________________________ Vehicle Identification

Number:___________________

Accident repair of: _______________________ Customer: _________________________

Dealer: __________________________________ Dealer number: _____________________

According to Directive 3200.. "Information on Replacing Steering Box After Accident Damage" issued by the manufacturer, the steering box should be replaced after a vehicle has been involved in an accident, including experiencing driving conditions similar to an accident, if any of the following points are applicable.

Damage, permanent deformation or fractures to:

The points marked have been deemed to be damaged as a result of the accident, or driving conditions similar to an accident, in which the above-referenced vehicle was involved.

IMPORTANT: The vehicle's operating license will be invalidated whenever the function of any of its safety components is compromised!

The customer/insurer acknowledges that the points marked above have been deemed to be damaged as a result of the accident, or driving conditions similar to an accident, in which the above-referenced vehicle was involved. The customer/insurer further acknowledges that in such instances, the directive issued by the manufacturer requires the steering box to be replaced. Notwithstanding the foregoing, the customer/insurer has chosen not to accept replacement of the steering box as directed by the manufacturer, and thereby assumes full and sole area of responsibility for the continued operation of the steering box in the above-referenced vehicle, including any technical, mechanical or legal consequences.

____________________________________________

Stamp/Signature (customer and insurer)