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CLAIM FORM: PBC-01-12-21-216
Date: 01.12.21

Claim form to exchange scrap goods

Customer fills

Claimed goods

Row item Row symbol Row name Row unit Invoice Nr. Description of the defect

Transfer of claimed goods

Filled in by the PAWBOL Baltic representative

Pawbol baltic comment
Date of app Signature of person

Two printed copies are required in case of sending goods with carrier.