Form test

Contact information

First name*

Last name*

Job title

Company*

Address*

Country*

Email*

Phone*

Fax

Product information

Product type*

Product

Part number (PNR)*

Serial number (SER)*

Hidden

Unknown serial number?

Serial number unknown

Ex product:*

Yes
No

SIL product:*

Yes
No

Purchase order number:

Either customer purchase order number, Meggitt Sales Order number or Meggitt Invoice number or Meggitt Delivery Note number

Date of purchase:

Product under warranty*

Yes
No
Warranty status unknown

Site where installed:

End user: Full name and complete address (incl. phone, fax, e-mail and website) of the end-user and the end-use location:*

Return information

Reason for return*

Type of problem

How long was the operating time before failure?

Description of failure:

Additional information:

Note: Please provide as much information as possible, in order to help with problem diagnosis.

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Ex product information (additional information required for Ex products only)

Hidden

Is the product installed in a hazardous area (potentially explosive atmosphere)?

Yes
No

Hidden

Additional information:

Hidden

SIL product information (additional information required for SIL products only)

Hidden

Is the product installed in a safety-related system?*

Yes
No

Hidden

In the safety-related system, did the system fail** in a safe mode? (That is, the safety relay operated but the trip was spurious.)*

Yes
No
Not applicable

** A faulty indicator LED is considered as a cosmetic failure.

Hidden

In the safety-related system, did the system fail** in a dangerous state? (That is, the failure did not result in the safe state.)*

Yes
No
Not applicable

** A faulty indicator LED is considered as a cosmetic failure.

Hidden

Additional information:

Note: For SIL products used in functional safety contexts/systems, the SIL product information section must be completed.

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Phone

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Form test

Energy product return form

Contact information

Product information

Return information

Ex product information (additional information required for Ex products only)

SIL product information (additional information required for SIL products only)

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