Customer Acknowledgement

Customer Acknowledgement

If the dealer finds a suspected counterfeit airbag and the customer does not want it replaced, the dealer should have the customer sign the following acknowledgement, before reinstalling the suspected counterfeit airbag.

The National Highway Traffic Safety Administration (NHTSA) issued a consumer safety advisory to alert vehicle owners and repair professionals to the dangers of counterfeit air bags. The NHTSA has also provided consumers with criteria and risk factors to help them evaluate whether their vehicles may be at risk.

We have completed an inspection of your vehicle's air bags to try to determine if any of your air bags may be counterfeit airbags. Your vehicle was inspected consistent with the NHTSA dealer guidance and consistent with air bag inspection procedures provided by General Motors. We have determined from our inspection that one or more of your air bags may be counterfeit and have recommended that the suspected counterfeit air bags be replaced with GM replacement air bags. You have elected not to replace the air bags at this time and have directed us to reinstall the suspected counterfeit air bags into your vehicle.

Before we reinstall the suspected counterfeit air bags please acknowledge the following:

1. Counterfeit air bags may not deploy or perform in the same manner as GM supplied replacement air bags.

2. Failure of the counterfeit air bags to deploy or to perform in the same manner as GM supplied air bags can lead to serious bodily injury or death to vehicle occupants in a crash.

3. We strongly recommend that you limit the driving of your vehicle until you are in a position to replace the suspected air bags.

4. You assume all responsibility for the risks associated with the operation of your vehicle with the suspected counterfeit air bags.

5. You can return to this dealership or to any authorized GM dealership if you later decide to have the suspect air bags replaced. The dealer will provide a cost estimate for the replacement air bags before any work is performed.

Customer Signature:

Date: