Certification of: _________________

Re. Steering box on:

Vehicle: ________________________________ Vehicle Identification Number:___________________

Accident repair of: _______________________ Customer: _________________________

Dealer: __________________________________ Dealer number: _____________________

According to Directive NOTES AND SPECIFICATIONS ON STEERING GEAR/STEERING COLUMN/STEERING SHAFT REPLACEMENT FOLLOWING ACCIDENT DAMAGE issued by the manufacturer, the steering box should be replaced after a vehicle has been involved in an accident, including experiencing driving conditions similar to an accident, if any of the following points are applicable.

Damage, permanent deformation or fractures to:

wheel rims in the event of a negative result from the wheel/axle alignment check
spring struts, steering stub axles and/or wheel carriers
wishbones
leading or trailing links or anti-roll bars with this function
body-side screwing/attachment point for wheel-guide control components
front axle support
pitman arms
tie rods
steering box features
steering column
visible or otherwise noticeable damage to the steering box
unacceptable torque increase and clamping when the steering box is turned from lock to lock (without hydraulic/electrical assistance)
fire damage

The points marked have been deemed to be damaged as a result of the accident, or driving conditions similar to an accident, in which the above-referenced vehicle was involved.

IMPORTANT: The vehicle's operating license will be invalidated whenever the function of any of its safety components is compromised!

The customer/insurer acknowledges that the points marked above have been deemed to be damaged as a result of the accident, or driving conditions similar to an accident, in which the above-referenced vehicle was involved. The customer/insurer further acknowledges that in such instances, the directive issued by the manufacturer requires the steering box to be replaced. Notwithstanding the foregoing, the customer/insurer has chosen not to accept replacement of the steering box as directed by the manufacturer, and thereby assumes full and sole area of responsibility for the continued operation of the steering box in the above-referenced vehicle, including any technical, mechanical or legal consequences.

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Stamp/Signature (customer and insurer)