Customer declaration, immobilization of front passenger airbag, certification

MODEL 204.3

At the express customer request, on your vehicle

With VIN:

____________________________________________________________

Vehicle identification number VIN

____________________________________________________________

Date

The function of the front passenger airbag has been permanently immobilized for the transport of a child restraint system on the front passenger seat. This measure means that in the event of a frontal impact there is an increased risk of injury for occupants on the front passenger seat, who are not secured in a child restraint system.

The customer was expressly notified that because of this particular measure the extra passive safety afforded by the front passenger airbag is no longer available, and therefore an increased risk of injury exists for an occupant on the passenger side who is not secured in a child restraint system. Particularly body regions such as head, neck and chest can be affected by reduced restraint.

To reduce any hazardous forward displacement of the upper body, the belt system on the passenger side has also been retrofitted.

The customer also agrees to notify vehicle users of the hazards and risks of injury involved.

The "Front Passenger Airbag Deactivated" and

"Pass Airbag Off" warning labels have been visibly affixed to the instrument panel.

--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(Copy sheet, separate here and stick top section into operator's manual at start of chapter on SAFETY)

Exclusion of liability, exemption and measures

2. I hereby release DAG from all third-party claims and indemnification as stated under (1).

3. Furthermore, I hereby commit myself to:

3.a ensuring that

- the above-separated specification is always kept with the operator's manual and

- that other users of the vehicle are informed thereof; and

3.b other users of the vehicle are notified of the change and the resulting related risk of injury.

3.c before resale, the previously-mentioned changes, i.e. immobilization of the front passenger airbag and the change to the belt system, have to be undone by a specialized garage and the insert and adhesive label removed.

1. I hereby renounce all claims against Daimler AG, its associated subsidiaries and its sales partners (together referred to as "DAG"), which arise - directly or indirectly - as a result of the modifications listed above and the associated increased risk of injury.

Date/stamp and signature
Mercedes-Benz service operation

____________________________________________________________

Date/signature of customer

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

Name and address of customer:

____________________________________________________________

Vehicle identification number VIN

Process customer request - standard

Immobilization of front passenger airbag

Customer: Inquiry

Workshop:

1. Provide information that decisions are made on an individual case basis

2. Check which version of the "Front passenger airbag immobilization" customer declaration is pertinent.

3. Instruction of customer about the dangers mentioned in the relevant version of the "Front passenger airbag" customer declaration

Customer and workshop:

1. Fill out facts form

2. Fill out "Front passenger airbag deactivation" customer declaration

- Leave modification date blank (important!)

- Signature of customers + stamp and signature of workshop,

3. Customer identification

- Copy of the ID

- Copy of the approval certificate

Sales

Send the filled-in forms (1+2) + copies (3)
by fax to the decision-maker (GSP/TP)

Fax no. +49-(0)711-3052182809

Decision-maker GSP/TP: - Archiving of faxed documents (1 - 3)

- Notification of O-code and password to workshop

Workshop:

1. Removal of existing adhesive labels (Warning symbols) for a rearward facing child restraint system or automatic child seat recognition (ACRSR) on passenger side of instrument panel.

2. Attachment of adhesive label A 204 817 77 20 (Warning symbols) "Front Passenger Airbag Deactivated" and "Pass Airbag Off". The adhesive label (Warning symbol) "Front Passenger Airbag Deactivated" must be affixed to the passenger side of the instrument panel instead of the adhesive label (Warning symbol) for child restraint systems. The adhesive label (Warning symbol) "Pass Airbag Off" must be stuck on below the hazard warning flasher switch. If a "Pass Airbag Off" lamp is present, the adhesive label must then be positioned such that the given warning system is covered up.

3. Replacement of passenger-side seat belt with following part numbers to match vehicle equipment

Part numbers of seat belts without belt force limiters:

 A 204 860 42 86 Right belt on left-hand drive vehicle without PRESAFE

 A 204 860 44 86 Right belt on left-hand drive vehicle with PRESAFE

 A 204 860 41 86 Left belt on right-hand drive vehicle without PRESAFE

 A 204 860 43 86 Left belt on right-hand drive vehicle with PRESAFE

Colors:

 9C94 Black

 8P19 Almond beige

 7F03 Alpaca gray

 3D53 300SL Red

4. Detach connections from front passenger airbag for ignition circuits (stage 1 and stage 2)

5. Conduct SCN coding for airbag control unit

6. Enter the date on the customer declaration which was previously left blank

7. Copy the customer declaration

8. Cut off and stick in the upper section of the original in the operator's manual (start of the chapter on Safety)

9. Transmit the lower section + copy of the complete customer declaration by telefax + by letter to the decision-maker (GSP/TPx)

10. Entry in service booklet (if available)

11. Recommendation to customer: Notification to insurance company

Archiving (GSP/TP): Archiving - the lower section of the original as well as

- Copy of complete customer declaration