Client Acknowledgement Form DECLARATION FORM FOR RESIDENTIAL PEST CONTROL SERVICE AIPM Agriclinic & Integrated Pest Management Private Limited SF 04, Second Floor, Jaiwant Complex, Sonarpeth, Bicholim, North Goa - 403504 Contact: 9607171409 | Email: info@aipm.org.in | Website: www.aipm.org.in Customer Category Commercial ResidentialEnter Your Business NameEnter Your Full NamePhone / MobileService TypeGeneral Disinfection (Ants , Cockroach , Lizard & Spider)Rodent ControlBeg Bug ControlTermite MaintenancePlant ManagementOtherImportant Safety Guidelines 1. Chemical UsageWHO-approved chemicals are safe when dry. Avoid contact while wet/semi-dry. 2. CleaningDo not clean for 2–4 hrs after service. Mop only with plain water (no phenyl/chemicals). 3. PetsRemove pets during service. Keep away until floors are dry & cleaned once. Remove bowls, toys, and bedding before treatment. 4. Children & ElderlyChildren, elderly, or those with respiratory issues should avoid treated areas for 2–3 hrs. 5. Kitchen & ElectricalCover/store all food items. Switch off or cover sensitive electronics. 6. SupportFor queries or reservice, contact +91-9607171409. Customer Declaration I have read and understood the above guidelines and will follow the required precautions.I agree that AIPM Pest Control will not be held responsible for non-compliance. Important Safety Guidelines  1. Chemical UsageWHO-approved, safe when dry. Avoid contact while wet/semi-dry. 2. CleaningDo not clean for 2–4 hrs. Use plain water only; avoid phenyl/chemicals for 24 hrs. 3. Food SafetyCover/store food, utensils & cutlery. No entry in kitchens/pantries till 2–4 hrs post-treatment. 4. Staff SafetyEmployees/visitors must vacate during service. Sensitive staff (elderly, pregnant, respiratory issues) to avoid area for 4 hrs. 5. EquipmentSwitch off/cover sensitive electronics. Keep refrigerators/appliances closed. 6. MonitoringDo not disturb bait stations/traps placed by technicians. 7. SupportFor service issues, contact +91-9607171409 | info@aipm.org.in. Customer Declaration I have read and understood the safety guidelines.I will ensure staff compliance post-treatment.AIPM Pest Control is not responsible for non-compliance. I have read and agree to the Terms and Conditions and Privacy PolicySubmit Form