Claim Form

CUSTOMER INFORMATION

Full Name:

Email Address:

Contact Number:

Company Name:

Address:

Consent for personal data to be used for claim administration By submitting this claim form, I hereby give my consent for Sirputis to collect, process, and use my personal data provided in this form for the purpose of claim administration. I understand that my personal data will be handled in accordance with applicable data protection laws and regulations.

PROJECT INFORMATION

Project Number:

Product Name:

Date of Purchase:

Invoice Number:

Project Manager (optional):

NATURE OF THE CLAIM

Please provide a detailed description of the issue or reason for the claim:

SUPPORTING DOCUMENTATION

Please upload any relevant supporting documentation, such as photos, videos, or invoices, to assist us in assessing your claim

RESOLUTION REQUESTED

Please specify the desired resolution or outcome you are seeking for your claim:

DECLARATION

I hereby declare that the information provided above is true and accurate to the best of my knowledge. I understand that any false or misleading information may result in the rejection of my claim.

Upon submission of the claim form, our team will review your claim and get back to you via the provided contact information.

Thank you for choosing Sirputis.

If you have any questions or need further assistance, please contact our team at info@sirputis.com or +370 41 200 695.

info@sirputis.com

info@sirputis.com

Thank you for choosing Sirputis.

JSC „Sirputis”

Dubijos St. 16, LT-77172 Siauliai, Lithuania

+370 41 200 695

info@sirputis.com

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