Warranty Claim by PyK5a1d

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									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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