ACCEPTANCE AND APPROVAL DECLARATION

ACTIVATE YOUR PERSONAL WARRANTY

(D.M. 27 agosto 1999, N. 332 – art. 4 comma 8-12)

As a personalized medical device, the Triride aid requires the activation of the personal warranty through the following form which must be fully completed.
The Triride device subject of this delivery, registered in the Medical Devices Register of Ministry of Health, represents a “Universal drive kit for wheelchairs” customized for the user.
The Triride should only be used in conjunction with a manual wheelchair to which it must be installed through specic clamps supplied at the time of delivery. The Triride can be used, both indoors and outdoors, exclusively according to the instructions of the “User and maintenance manual” delivered with the device. Any other use that does not correspond the “User and maintenance manual” specications may pose a danger for the user or third parties.
The terms and duration of the warranty are described in the “use and maintenance manual” of the device.

    BY FILLING IN THE FOLLOWING FORM THE SUBSCRIBED DECLARES:

    - To have received the "Triride" medical device from the orthopedics technician to be indicated in the field below;
    - That the assembly of the attachments was done by the technician who also checked the hooking and unhooking of the wheelchair;
    - To have received the explanations and to have made a practical test of all the operations necessary for the correct functioning of the device;
    - To be aware of the intended use of the device that has been delivered to him and to commit himself to always use the wheelchair equipped with the "Triride" appropriately;
    - To have received the "User and maintenance manual" and clear and exhaustive instructions for using the device and to know how to use it;
    - To understand how to activate the security systems of the device;
    - To know the local road trafic regulations for electric wheelchairs and scooters;
    - To be aware of the need to carry out routine maintenance operations and to adequately preserve the device in order to set up the guarantee, by keeping also its original packaging for an eventual shipment;
    - To exonerate "Triride S.r.l." from any civil and criminal liability, for any personal and property damage caused to itself or third parties in case of misuse of the instructions received with the “User and maintenance manual";
    - To be aware that any tampering or modification of the "Triride" carried out autonomously involves loosing the guarantee;

    Please indicate below the name of the technician who carried out the assembly and the name of the dealer company.
    The data are not mandatory but Triride SRL reserves the right to contact the user to request the missing information.

    Insert the serial number of your device (start with TRX, TRK or MTW) - (Where I found the serial number SN? More info)

    The undersigned:
    explicit to the processing of the category of data referred to in point 2 of the information privacy policy (particular categories of personal data - health data).
    Aware that failure to provide will prevent the execution of the contract.

    express consentdenies consent explicit to the treatment referred to in point 3 of the information privacy policy, of personal data (treatment for direct marketing purposes)

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    The undersigned declares to have read the information at the top of this document, to have understood and accepted its contents

    The Triride serial code is on the label applied to the frame of the device itself.

    The form must be completed in all its entries.

    The warranty starts from the billing date of the device.