Warranty Claim This claim is subject to rejection if parts prices Claim No. are not shown with FOB Japan Yen x coefficient Date of Issue Distributor’s Name Adress Dealer’s or OEM’s Name Adress Model and Serial No. Appl. of Engine Date of Sale Date of Trouble Work. Hours Frequency of Trouble Where happened Date of Repair Technical Information Part Name Part No. Q‘ty Unit Price Amount Total Parts Descr. of Work Oper.No Sched Time Lab. Amount Total Labour Claim Parts have to sent back Claim approved by Date We hereby certify that the information mentioned above Checked by is true and correct judging from our knowledge and experience. Approved by _________________________ Signatur of Distributor or OEM Claim returned code no. Claim denied code no.
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