Schadeformulier International School Utrecht

student data
First name*
Last name*
Class*
Student numberr*
E-mail*
E-mail parents*
Phone number*
Phone number Parents*
Device*
Brand and type of device*
Serial number*
Damage / Theft*
Date of damage / Theft*
Reported to police?*
Declaration number and place
Where and how was the equipment stored*
Descripe exactly what has happend*
What damage does your device have?*
Location where damage occurred*
Time when the damage occurred*
Was the protective cover used?*
Unlock code for your device*
Return address + house number
Return Address Zip Code
Return address City

By pressing ‘send’ you indicate that the form has been completed truthfully by the parents of the pupil. In case of fraud, a report will be made to the police.

student data