Warranty Claim by PyK5a1d


									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
                                                              Approved by

Signatur of Distributor or OEM
Claim returned code no.                              Claim denied code no.

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