WARRANTY CLAIM FORM

Dealer
Name: PT. INDOTRUCK UTAMA Claim Submitted By: Agung
Claim No.: ITU/093/11/SBP Date: 14-Mar-11

Owner
Name: PT. SARANA BAJA PERKASA Person in charge: Mrs. Yuli
Address: MEDAN

Tel: Fax:

Product
Machine Model: DRF 450-60 S5K Serial No. H11300186
Delivery Date: 6-Oct-08
Running Hours: 4963 Trans S/N : KBEA 340984 - 12/08

Failure
Location of Failure: TRANSMISSION
Descriptions:
COMPLAINT : * Machine can't move reverse
CAUSE : * Low clutch pressure on RVS gear (probably internal leaks on piston).
CORRECTION : * Overhaul transmission.

Date of Failure: 09-Mar-11 (dd.mm.yy) Date of Repair:

Parts Used
Part No.: Description: Quantity: Unit Price: Amount:
923855.1433 CLUTCH OUTER DISC 22
923855.1469 CLUTCH OUTER DISC 18
923944.1493 CLUTCH INNER DISC 23
923944.1492 CLUTCH INNER DISC 40
923944.1494 CLUTCH OUTER DISC 21
923944.1495 CLUTCH STEEL PLATE 4
923976.3305 SEAL KIT TE32 1
923976.2819 ROLLER BEARING 1

Local Repair Local Services: Local Parts Purchased: 0.00

Invoice No.: Invoice Amount:
Descriptions of Repair:

Descriptions of Service:

Parts Purchased: Amount: (Pls indicate currency)

This section to be filled by Cargotec only.

Factory Claim No.:
Scala No.:
Claim Handle by:
Date:
r-11

uli

(dd.mm.yy)

(SGD)

ndicate currency)