Medklinn Service Form

Medklinn Service Form
Unit sent in by*

Walk-in at Medklinn Service CentreSend via courier (Customers are requested to send in the units at their own cost)
Kindly ship back your Medklinn unit to the following address:

Medklinn Service Centre (T: +603 55670788)
22, Jalan Pengacara U1/48,
Temasya Industrial Park,
40150 Shah Alam, Selangor
Courier Service Name
Tracking Number
Full Name*
Name
Phone Number*

Area CodePhone Number
NRIC/Passport No.*
E-mail*
example@example.com
Address (for Delivery)*

Address Line 1

Address Line 2

CityState

Postcode
Number of units*

12345
Product Model 1*
Serial Number 1*
Sent in with 1*

Unit only - with cartridge in the unitUnit only - without cartridge in the unitAdaptorUSB CableAdditional CartridgeOriginal Box/PackagingOther
Reason for Service 1*
Product Model 2*
Serial Number 2*
Sent in with 2*

Unit only - with cartridge in the unitUnit only - without cartridge in the unitAdaptorUSB CableAdditional CartridgeOriginal Box/PackagingOther
Reason for Service 2*
Product Model 3*
Serial Number 3*
Sent in with 3*

Unit only - with cartridge in the unitUnit only - without cartridge in the unitAdaptorUSB CableAdditional CartridgeOriginal Box/PackagingOther
Reason for Service 3*
Product Model 4*
Serial Number 4*
Sent in with 4*

Unit only - with cartridge in the unitUnit only - without cartridge in the unitAdaptorUSB CableAdditional CartridgeOriginal Box/PackagingOther
Reason for Service 4*
Product Model 5*
Serial Number 5*
Sent in with 5*

Unit only - with cartridge in the unitUnit only - without cartridge in the unitAdaptorUSB CableAdditional CartridgeOriginal Box/PackagingOther
Reason for Service 5*
Proof of Purchase (Receipt/Warranty Certificate)

Cancelof
An administrative and troubleshooting fee of RM50 per unit is applicable and will only be waived upon confirmation to repair/service.*

I agree
Unit to be sent back by*

Self-collection at Medklinn Service CentreSend via courier to the above address (Free shipping)
Customer Signature*

Clear
I hereby agree and acknowledge that i have carefully read the terms and conditions, understand the contents herein, freely and voluntarily assent to all of the terms and conditions hereof, and sign my name of my own free act. (IMPORTANT NOTE: Actual service time will vary depending on the diagnostics, repair required, parts availability and total shipping time. Medklinn will make every effort to complete depot repairs with expediency and provide you with estimates at the time of service.)
To be filled in by Medklinn.

For customers, kindly proceed to preview and submit.
Servicing Completed

YesNo
Unit received by*
Date of Service*

DayMonthYear
Date
Service Summary*
Service Comments:
Unit under Warranty*

YesNo
Service Fee (RM)*
3 months warranty for spare parts replacement*.

*Cartridge is not included as it is a consumable part which requires yearly replacement.
Unit sent back by*

Self-collection at Medklinn Service CentreSend via courier
Courier Company & Tracking #*
Should be Empty: