FIELD SERVICE REPORT

Beckman Coulter India Pvt. Ltd. No.: Date:

CUSTOMER NAME: MODEL:
SERIAL NO:
WARRANTY ACTIVE OWNED OTL/CONTRACTS INSTANCE NO:
SERVICE REQUEST NO:
TASK NO:
DEPARTMENT: DATE TIME TYPE OF CALL
CONTACT PERSON: COMPLAINT RECD INSTALLATION
ADDRESS: RESPONSE DE-INSTALLATION
COMPLETION PM VISIT
HRS MINS BREAKDOWN
CITY/POSTAL CODE: LABOUR HRS MODIFICATION
STATE COUNTRY: TRAVEL HRS APPLICATION
MOB/TEL No: TOTAL HRS DEMO/OTHERS
E-MAIL:

PROBLEM REPORTED/SYMPTOM:

OBSERVATIONS/CAUSE:

ACTION TAKEN/ RESOLUTION:

VERIFICATION OF REPAIR:

VERIFICATION STATEMENT:

FOLLOWING PARTS HAVE BEEN REPLACED FROM – BECKMAN COULTER OR CUSTMER STOCK
Sr. No. PART No. DESCRIPTION UNIT PRICE QTY TOTAL NS
1.
2.
3.
4.
(Taxes Extra) TOTAL Rs.

ADDITIONAL COMMENTS:

CF RAISED Y/N IF YES CF TYPE.

We approve the above changes.
I certify that the above work has been carried out to my satisfaction.

ENGINEERS NAME & SIGNATURE CHECKED BY CUSTOMER SIGNATURE

Head Office: Unit Nos.TF-B-07(A) to 15, 3rd Floor, B Wing, Art Guild House Phoenix Market City, LBS Road Kurla West, Mumbai- 400 070
Tel: +91 22 3080 5000 Fax: +91 22 3080 5060
Toll Free Number: 18002009340 Email: bclsservice@beckman.com