Customer declaration for deactivation of driver sidebag, certificate · of9160s100022e · Mercedes-Benz WIS

OF91.60-S-1000-22E

Customer declaration for deactivation of driver sidebag, certificate

Model

447

 Before deactivating the driver sidebag, it is essential to ensure that the declaration is signed by the customer.
In the case of reactivation at a later date, this statement is to be stamped and signed by a representative of the Mercedes-Benz service operation at which the reactivation is carried out.

Deactivation of driver sidebag at customer's request
In response to a clearly-stated customer request, the driver sidebag will for medical reasons be deactivated on the vehicle with vehicle identification number: ............................................................................................................... For this reason, modifications to the standard control unit of the restraint system components had to be performed at the request of the customer. As a result of these measures, the driver sidebag will no longer function.	 Risk of injury! Once deactivated, the protection provided by the driver sidebag is no longer available. The customer is expressly informed of this increased risk of injury and is obliged to notify third parties of the situation before allowing them to use the vehicle.
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(Please copy this sheet, cut off here and stick the upper section into the operator's manual at the start of the chapter on SAFETY.)

Certificate of compliance, exemption and measures
1.	The customer declared that he is aware of all the hazards and injury risks involved in connection with his requested change, as mentioned above. The customer's signature indicates that the customer expressly approved of such a change.
2.	The customer is aware that on account of his requested change and – as a consequence – his expressly declared approval of the attendant, increased hazards and risks of injury, no claims can be expressed against Daimler AG, its group member companies or its sales partners, which arise – directly or indirectly – because of the above-mentioned change and the related increased risks of injury.
3.	The customer hereby releases Daimler AG from all third-party claims and indemnification as stated under 2.
	Vehicle identification number: ............................................................................................................	Name and address of customer: ........................................................................................................... ........................................................................................................... ...........................................................................................................
4.	The customer is aware that reactivation of the above-mentioned deactivated safety components can only be performed by a Mercedes-Benz service operation. The service operation must restore the condition of all functions and confirm this.

Confirmation of reactivation
	Vehicle identification number: ............................................................................................................	Date/stamp/signature of MercedesBenz service operation: ............................................................................................................ ............................................................................................................
5th	Furthermore, the customer hereby undertakes:
	a. to report the modifications to the vehicle licensing agency and to make a corresponding entry in the vehicle documents; and
	b. to ensure that
	 the above-separated specification is always included with the operator's manual and
	 other users of the vehicle are informed thereof; and
	c. to inform other users/purchasers of the vehicle in full of the modifications and the related hazards and risks of injury involved, and to document this.
	Date/signature of customer ............................................................................................................	Date/stamp/signature of MercedesBenz service operation ............................................................................................................ ............................................................................................................