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Service request form

    Information about the boiler

    (Please fill all fields below)

    Boiler serial number*
    Boiler model
    Purchase date
    Defect description
    Date of boiler fault



    User data

    (Please fill all fields below)

    Name
    Street
    Number
    Town
    Postcode
    E-mail
    Phone number


    Installer data

    (Please fill all fields below)

    Company
    Phone number


    Claimant ServicemanInstallerUser

    I therefore declare I have read and accepted the warranty terms and conditions provided together with the boiler.

    I represent that I agree to have my personal data processed by NIBE-BIAWAR SP. Z O. O. with seat in Białymstok, al. Jana Pawła II 57, on the basis of Art.6 sec. 1 a,b,c, within the scope necessary for service request management. Data submission is voluntary, but is nescessary in order to execution of a request. The legal basis of the data processing is my consent. The personal data are going to be processed either up to the end of request execution or withdrawal of the permission. I hereby declare that I have been informed that that I have the right to access, correct and request the erasure or restriction of processing my personal data as well as lodge a complaint with a supervisory authority.

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