Reconnecting The Passenger Side Airbag (SRS), Approval

To be filled out by the workshop that carries out the procedure:

Car model:

Chassis number:

Registration number:

Odometer reading:

Workshop responsible:

Town:

Date (year-month-day):

To be filled in by the vehicle owner:

Vehicle owner's address:

Post code and town:

I, the undersigned, acknowledge that the passenger airbag has been reconnected. I understand that the passenger airbag will function according to the manufactures specifications from the date listed above.

Vehicle owner's signature:

Name:

Workshop manager's signature:

Name: