RMA REQUEST FORM

908 Canada Court City of Industry, CA 91748 RMA REQUEST form PLEASE FILL form OUT COMPLETELY RMA #: .. DATE REQUEST : .. *TECH ID #: .. *Dealer Code #: .. (*Please choose either Tech ID or Dealer Code to fill in.) PURCHASE FROM: .. YOUR NAME: .. YOUR PHONE: .. YOUR COMPANY NAME: .. Hikvision WILL RETUR ITEM(S) TO: YOUR ADDRESS: .. ATTN to: .. STATE: .. ZIP: .. YOUR PHONE: .. YOUR FAX: .. QTY Model Number # Serial Number # (Must be complete & accurate for us to process your REQUEST ) Description of problem (Failure to include a detailed description will result in RMA REQUEST to be auto-declined) REQUEST TYPE: (Please cross out box) Return for repair Return for Credit Customer Comments: NOTE: ** PACKAGES WITHOUT RMA NUMBER ON THE BOX WILL NOT BE ACCEPTED ** ENCLOSE A COPY OF THIS form IN THE PACKAGE AND SEND ALL RETURNS TO: Hikvision USA, Inc.

Rev 10.16.12 (Effective November 1st, 2012) Page 3 Repairs: For Repair RMA’s the customer completes the RMA form indicating as much information so as to assist the repair department with diagnosing and repairing the item. Once the item is received the appropriate repair technician determines warranty status by checking

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