Service Form | Malaysia

1
Reference Number
2
Please take note that this form serves as a notification to Medklinn receiving team and not a service pickup form* This field is required.
3
Which courier service are you using to send back the unit?* This field is required.
Pos Laju
GD Express
City Link
Ninja Van
Yamato Transport (TaQbin)
Skynet
Others
4
Others* This field is required.
5
Full Name* This field is required.As per identity card
6
NRIC/Passport No.* This field is required.
7
Mobile* This field is required.
8
E-mail* This field is required.
9
Address* This field is required.
Address
Street Address
City
State
Postcode
Malaysia
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Please upload the proof of purchase.Warranty card or original receipt for warranty claim.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
11
Number of Unit(s)* This field is required.
Please Select
Please Select
1
2
3
4
5
6
12
Product Model 1* This field is required.
Please Select
Please Select
Autoplus
Asens+20
Asens+40
Asens+60
Versa
Versa 25
Versa 45
PRO AS1
PRO AS2
PRO AS180
PRO AS20P
PRO AS30P
PRO AS40P
Asens Auto
Asens
Asens Premium
Haven
Mobile
Product model
Ex: 348-BB-01-12345
Reason for service
Please Select
Please Select
Under warranty
No warranty
Warranty status
Please Select
Unit only
Adaptor/Power Plug
Warranty Card/Receipt
Original Box
Product sent in with
13
Product Model 2* This field is required.
Please Select
Please Select
Autoplus
Asens+20
Asens+40
Asens+60
Versa
Versa 25
Versa 45
PRO AS1
PRO AS2
PRO AS180
PRO AS20P
PRO AS30P
PRO AS40P
Asens Auto
Asens
Asens Premium
Haven
Mobile
Ex: 348-BB-01-12345
Reason for service
Please Select
Please Select
Under warranty
No warranty
Warranty status
Please Select
Unit only
Adaptor/Power Plug
Warranty Card/Receipt
Original Box
Product sent in with
14
Product Model 3* This field is required.
Please Select
Please Select
Autoplus
Asens+20
Asens+40
Asens+60
Versa
Versa 25
Versa 45
PRO AS1
PRO AS2
PRO AS180
PRO AS20P
PRO AS30P
PRO AS40P
Asens Auto
Asens
Asens Premium
Haven
Mobile
Product model
Ex: 348-BB-01-12345
Reason for service
Please Select
Please Select
Under warranty
No warranty
Warranty status
Please Select
Unit only
Adaptor/Power Plug
Warranty Card/Receipt
Original Box
Product sent in with
15
Product Model 4* This field is required.
Please Select
Please Select
Autoplus
Asens+20
Asens+40
Asens+60
Versa
Versa 25
Versa 45
PRO AS1
PRO AS2
PRO AS180
PRO AS20P
PRO AS30P
PRO AS40P
Asens Auto
Asens
Asens Premium
Haven
Mobile
Product model
Ex: 348-BB-01-12345
Reason for service
Please Select
Please Select
Under warranty
No warranty
Warranty status
Please Select
Unit only
Adaptor/Power Plug
Warranty Card/Receipt
Original Box
Product sent in with
16
Product Model 5* This field is required.
Please Select
Please Select
Autoplus
Asens+20
Asens+40
Asens+60
Versa
Versa 25
Versa 45
PRO AS1
PRO AS2
PRO AS180
PRO AS20P
PRO AS30P
PRO AS40P
Asens Auto
Asens
Asens Premium
Haven
Mobile
Product model
Ex: 348-BB-01-12345
Reason for service
Please Select
Please Select
Under warranty
No warranty
Warranty status
Please Select
Unit only
Adaptor/Power Plug
Warranty Card/Receipt
Original Box
Product sent in with
17
Product Model 6* This field is required.
Please Select
Please Select
Autoplus
Asens+20
Asens+40
Asens+60
Versa
Versa 25
Versa 45
PRO AS1
PRO AS2
PRO AS180
PRO AS20P
PRO AS30P
PRO AS40P
Asens Auto
Asens
Asens Premium
Haven
Mobile
Product model
Ex: 348-BB-01-12345
Reason for service
Please Select
Please Select
Under warranty
No warranty
Warranty status
Please Select
Unit only
Adaptor/Power Plug
Warranty Card/Receipt
Original Box
Product sent in with
18
Can you detect any hissing sound from the unit?
YESNO
19
Can you see any purple glow on the module/cartridge of the unit?
YESNO
20
Is the LED light of the unit on?
YESNO
21
How would you like us to return your unit?* This field is required.
Self Collection
Send via courier to the above address (free delivery)
22
Terms and Conditions for Warranty Claims or Servicing* This field is required.
23
Privacy Policy* This field is required.
24
Additional Remarks to Service Centre
25
Customer Signature* This field is required.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.)
26
Thank you for completing the Service Form.
We've emailed you a copy of the completed Service Form.

IMPORTANT: Please print it out and send it along with your unit(s).
Should be Empty: