POLICY / WARRANTY
NOTIFICATION
FROM:
Pon Power A/S
Baltorpbakken 14
DK-2750 Ballerup
(DAMAGE REPORT)
FOR CATERPILLAR PRODUCT
KNOWN AS MAK PRODUCT
Phone:
Fax:
E-mail:
Person in charge:
Work Order:
Ship’s Name
Engine No.
Engine type
Required action
Delivery of
spare parts
Service
required
Yes / No
Yes / No
Engine put
End of
in operation warranty
Claim No.
Failure
Further action
corrected by
required
the team of PS
Yes / No
Yes / No
Failure already
advised by
phone
Yes / No
Failure or damage description (If possible/helpful with sketch from catalogue or photo)
Defective part
Qty
S/P No.
Date of failure Hours engine Hours part
Type and serial no.
Manufacturer if known:
Possible cause of failure or damage / Remarks for further action
Additional necessary
parts
Qty
Catalogue
No.
Additional necessary
parts
Consignee of required spare
parts
Additional details:
Spare parts will be supplied by:
Service will be done by:
Internal Remarks KEC
Dept.
Catalogue No.
Details
Phone:
Fax:
E-Mail
Contact person:
Port of destination:
Transport:
Latest arrival:
Company:
Date
Name
Action released by
Everything printed in bold is absolutely necessary
Caterpillar Confidential: Green
Version 1/03-06-2010/KYD
Qty
Approx. costs:
Signature