(i) Has the piece of equipment been modified to apply a manufacturer's code? ………..........................................………………………………………………… (ii) If so, state the manufacturer's code that each such piece of equipment has been modified to apply:……….......................................................…………………….. (iii) State the name and physical address of the consignor, and, if different, the seller:…………………...........................................………………………………. ......................……………………………………………………………………… (iv) State the name and physical address of the consignee, and if different, the purchaser:…………...............................………………………………………….. …………………………………………......................…………………………… …………………………………………………………......................…………… Undertaking I, …………………………………………………….....................................................................................................................……………………do hereby affirm that I have the authority to furnish the information provided above and that the information provided is to the best of my knowledge true and correct. Name:………………………………………………………………....................................................................................................................................……. Designation:………………………………………………………………............................................................................................................................. Address:…………………………………………………………………................................................................................................................................... ……………………………………………………………………………......................................................................................................................................... Signature: ……………………………… 13 13 Date: ……………………………