Order form EU Grid – Inverter Test (Page 1 of 2 ... - PHOTON Info

Statutory declaration in lieu of an oath concerningthe test agreementEU Grid – Inverter Test (Page 1 of 1)Inverter model ___________________________________________________________________________________________________________________________Statutory declaration in lieu of an oath concerning the test agreementLast nameFirst nameRole within the companyZIP codeTown_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Excerpt from the German Criminal Code (StGB))§ 156 StGB False statutory declaration in lieu of an oathIf you make a false statutory declaration in lieu of an oath vis-à-vis an authority responsible for theacceptance of such or if you make a false statement under reference to such a declaration, you maybe punished with up to 3 years imprisonment or a fine§ 161 StGB Negligent false statutory declaration in lieu of an oath(1) If one of the actions mentioned in §§ 154 to 156 has been carried out due to negligence, youmay be punished with up to 1 year imprisonment or a fine.(2) Impunity will occur if the offender corrects his false declaration in time. The regulations of §158, paragraphs 2 and 3 shall apply accordingly.I have noted the meaning of the statutory declaration in lieu of an oath and the penal consequences(cf. above) of an incorrect or incomplete statement. Therefore, I declare oath the completeness andcorrectness of my information regarding the test agreement of _______________, that the deviceprovided for the testManufacturerTypeModelWith serial / article number____________________________________________________________________________________________________________________________________________________________________________________________________is non-manipulated, standard equipment (of average type and quality).I affirm the correctness of my preceding declaration. I affirm in lieu of an oath that I have told thewhole truth to the best of my knowledge and that I have not concealed any information.Location, date ________________Signature ________________________________________PHOTON Laboratory GmbH • Juelicher Strasse 376 • 52070 Aachen (Germany)Phone +49 – 241 / 40 03 – 53 00 • Fax +49 – 241 / 40 03 – 57 00 • info@photon-laboratory.com