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DELIVERY CLAIM FORM

Dealer's Claim (Ref) No. Date of Claim YMPH Claim (Ctrl) No. YMPH SPOS (Ctrl) No.

Dealer Code (Sold To) Dealer Name Outlet (Shipped To) Outlet Name

Region (c/o YMPH) DRMC No. Claim Description


NCR VIS
LZN MIN
Claim Type Affected Models Color(s) Engine(s)

Unit

Motorcycle Parts Portion (rider's L/R) Findings Qty QCN Check (c/o YMPH)

1. Signal Light
2. Head Light
3. Seat
4. Tail Light
5. Rear Fender
6. Muffler
7. Body
8. Others
TBA a) Wrong TBA Qty b) no lacking TBA Qty
Should be
this model
Claimant's Name Designation Signature

YAMAHA MOTOR PHILS, INC. - Sales Order Processing Group - 2/F Twin Oaks Place 1, #750 Shaw Boulevard Cor. Plymouth St., Greenfield
District, Mandaluyong City. TEL NO. (02) 585-1380,(0917)5654028, (02) 623-6352, (0917) 5851380 FAX NO. (02) 535-2158

For YMPH Use Only


Defective Parts (date) Prepared by:
Received
Not yet (ETA)
(signature over printed name) (date)
YMPH Judgment Justification Noted by:

Approved (signature over printed name) (date)


Rejected Approved by:

(signature over printed name) (date)


Remarks Received by:

(signature over printed name) (date)

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SS-PR-002 FM001 rev00

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