BECKMAN FIELD SERVICE REPORT

COULTER, 30904
Beckman Coulter India Pvt. Ltd.
No.: Date: 112202
CUSTOMER NAME:B Bosua, CamaY MODEL: DAPuy
SERIAL NO: AD 284 00
WARRANTY: V ACTIVE OWNED OTL INSTANCE NO: 777961F3
SERVICE REQUEST NO. (S.R NO.): WO-034&067
TASK NO: CM-36S 41/9
TYPE OF CALL
DEPARTMENT: DATE TIME
CONTACT PERSON: : COMPLAINT RECD INSTALLATION
Kp. -

DE-INSTALLATION
ADDRESS: RESPONSSE
COMPLETION
i 17 PM VISIT
MINS BREAKDOWN
baopinnhns*
CITYI POSTALCÓDE:mdlt J8I06 LABOUR HRS
HRS
2 MODIFICATION

TRAVEL HRS APPLICATION

STATE/ COUNTRY:
MOB.TEL. No. 8826 loy)8 TOTAL HRS
E-MAIL
PROBLEM REPORTED/ SYMPTOM: PM t be loe

OBSERVATIONS/ CAUSE dul

ACTION TAKEN/RESOLUTION Per

Alnser dnd a n om daiuca
VERIMCATION OF REPAIR:"

VERIFICATION STATEMENT () THE COREECT OPTION Results meet published

to meet the specified requirements as per established procedures.
| Sanvice activity performed is verified
performance specifications.
Werified as per established procedures. Documented Verificationin
Service Report Debrief Notes.

FROM BECKMAN COULTER OR CUSTOMER STOCK

PARTS HAVE BEEN REPLACED
-

FOLLOWING
QTY TOTAL NS
DESCRIPTION UNIT PRICE
Sr.No. PARTNo.

3
4 Taxes Extra) TOTALRs.

ADDITIONAL COMMENTS:

CF RAISED Y/N IF YES CF TYPE

We approve the above charges.

has been camied out to my satisfaction.
certify that the above work

CHECKED BY
uaiCUSTOMER SIGNATURE
ENGINEERS NAME SI¢NATURE-
&

LBS Road, Kurla (West), Mumbai- 400 070

Head Office: Unit Nos.TF-B-07(A) to 15 Third Floor, Wing B, Art Guild House, Phoenix Market city,
Telephone: 6838 5000, Fax: 6838 5060/61