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Incident Details *

Manufacturer *

Part Number and Quantity *

Name *

Reported to *

Wholesaler/ Authorised Dealer *

Date *

Damage Code to Record *Damage Description Code - Zone Description Code - Severity Description Code - Description Code (e.g. I-C2-3-G5)

EXAMPLE I-C2-3-G5 = IMPACT, BOTTOM MIDDLE, DAMAGE IS MAJOR AND WAS DONE IN TRANSITFOR PRODUCT QUALITY FAULTS PLEASE ALSO ATTACH PQFA FORM

Supplying Branch/DC *

Email *

Additional Information