Letter of Responsibility

Delivery of work equipment

Date of delivery: ______/_______/_______/

I received the following equipment from the laboratory:

Equipment or tool: _____________________________________________________

Brand: ____________________________________ Model: _______________________

Serial number: ____________________________

Which is delivered to me in optimal conditions for its proper use, committing myself to
take care of it, keep it in good condition, and use it only and exclusively for matters related
to my work activity. In case of loss, damage or improper use, I am responsible for the cost
of repair or replacement of the equipment.

RECEIVED: NAME AND SIGNATURE _________________________________

DELIVERY: NAME AND SIGNATURE_____________________________________

 Letter of Responsibility
Delivery of work equipment

Date of delivery: ______/_______/_______/

I received the following equipment from the laboratory:

Equipment or tool: _____________________________________________________

Brand: ____________________________________ Model: _______________________

Serial number: ____________________________

Which is delivered to me in optimal conditions for its proper use, on a temporary basis
with devolutive character, committing myself to take care of it, keep it in good condition,
use it only and exclusively for matters related to my work activity. In case of loss, damage
or improper use, I am responsible for the cost of repair or replacement of the equipment.

RECEIVED: NAME AND SIGNATURE _________________________________

DELIVERY: NAME AND SIGNATURE_____________________________________

DATE OF RETURN: _______/_________/_________/

RECEIVES RETURN: NAME AND SIGNATURE_______________________________