Panasonic WH-416KZ Operating Instructions Manual page 40

Information
For your reference
Name of Owner:
Hearing Instrument Dispenser:
Dispenser Address:
Dispenser Phone:
Purchase Date:
Hearing Instrument Model Number:
Hearing Instrument Serial Number:
Receiver Model Number:
Receiver Serial Number:
*The serial number is printed on the package label.
40
(Continued)
(Fill out when you purchase your hearing aid)