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Service Card

CCBRT MAINTENANCE WORKSHOP

Hospital, City

________________________________________

Maintenance

Department

________________________________________

Repair

Contact Person

________________________________________

Warranty

Contact Number

________________________________________

Emergency

Equipment

________________________________

Serial Number ________________________________

Model

_________________________________

Accessories _________________________________

Problem Description __________________________________________________________________________


__________________________________________________________________________

Spare Parts

Spare Parts

Consumables

Price of Item

Total Price

(solder, cable ties, screws, cleaning material...)

Total

Hours

Technician

Date

Hours

Mileage

Work

Mileage

Work

Date

Technician

Comments

Requested by (Customer)

___________________

Signature _________________ Date ____________

Received by (Technician)

___________________

Signature _________________ Date ____________

Returned by (Technician)

___________________

Signature _________________ Date ____________

Received by (Customer)

___________________

Signature _________________ Date ____________

Service Card #

CCBRT Maintenance Workshop

Invoice #

P.O.Box 23310

Dar Es Salaam

Date

022-2666197

ccbrt.hospital.maintenance@gmail.com

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