Branch/Agency company no. Customer
Vehicle ident No. Repair order no.
Tester: Name Date
License plate No. Original registration date Model Engine no. odometer reading: km/miles
Confirmation of immobilization/nonfunctionality of TELE AID system
The TELE AID system does not function because of the following reason:
At my express (customer) request the function of the TELE AID system and the indicator lamp/fault messages were immobilized.
Mercedes-Benz has notified me that because of this measure the additional passive safety of an automatic or manual emergency call is no longer available.
If the indicator lamp does however light up, there is a fault in the system and it has to be repaired at a Mercedes-Benz Service Station.
I hereby abandon all claims arising from immobilization of the TELE AID system against Daimler AG, irrespective of the legal basis involved.
Furthermore, I also declare that I shall notify the purchaser of this vehicle or any person to whom the vehicle is entrusted that this particular function has been disabled.
A sticker has been attached to the TELE AID button which indicates that the TELE AID system has been immobilized and that it may not be removed unless the TELE AID system is activated by a Mercedes-Benz Service company.
When the vehicle was shipped to the customer the TELE AID system was unable to be enabled. To enable the TELE AID system the customer is asked to bring his/her vehicle to the workshop on the morning of ..............................
Chassis identification no. WDB
Dealer stamp and signature Date, customer signature
Name of salesperson Name of customer