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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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