Warranty Claim form

ID :241203-652577

You have to fill everything which marked with red!

Szakal Metal shop/office :

Choose where you wish to send the items

BUYER

Name :

Name of inviduals, or the name of the Company

Address :

Adress, Country, Town, Street house Nr.

Phone :

Phone number

E-mail:

E-mail address to send copy

Vehicle:

Make :

ex Skoda, Opel, Volkswagen

Type :

Exact type with parameters

Capacity (ccm) :

ex. 1970

Year :

Give the model year

Power (kW)

Chassis Nr. :

Chassis number must 17 character long!

Engine code / number:

Fuel :

Chose the type of the a fuel

Invoice parameters:

SZM Invoice Nr. :

Date of purchase : . Year . Month Day

Article Nrs for Warranty / Quantities :

Art. Nr. Quantity

Type here the Art. Nr form the Invoice for the Warranty

Date of Built-In : . Year . Month Day

Total KM when Built-In:

Date of disassembling : . Year . Month Day

Total KM when dissasembled :

Total KM of Dissassembling couldn't be less than the Total KM of Biult-In. Otherwise Warranty is not allowed.

More replaced items :

Type here all the parts which were replaced during Built-in

Approval

Aprroval for destructive testing

Yes No

The problem

About :

Give us detailed information about the problem which occoured.
*

What is the reason for replacement

Write down why needed to replace the required part!