Warranty Request From

YOUR DETAILS

PROGRAM *

C919

C909

NAME *

TEL *

EMAIL *

AIRLINE

CLAIM No.

DATE OF CLAIM

AIRCRAFT

MSN (Manufacturers Serial Number):

A/C REG (Aircraft Registration Number):

TR S/N (Thrust Reverser Serial Number):

A/C FH (Flight Hours):

A/C FC (Flight Cycles):

Eng SN (Engine Serial Number):

CLAIM #1

CLAIM 1 TYPE: *

Service Bulletin

Part Claim

Service Bulletin Reference No.

COMPENSATION TYPE: *

FOC (Free of Charge) Part

Credit Note

PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

CLAIMED LABOR COST $

OTHER COST CLAIMED $

OTHER COST CLAIMED DETAILS

TOTAL AMOUNT CLAIMED $

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CLAIM #2

CLAIM 2 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

CLAIMED LABOR COST $

OTHER COST CLAIMED $

OTHER COST CLAIMED DETAILS

TOTAL AMOUNT CLAIMED $

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CLAIM #3

CLAIM 3 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

CLAIMED LABOR COST $

OTHER COST CLAIMED $

OTHER COST CLAIMED DETAILS

TOTAL AMOUNT CLAIMED $

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CLAIM #4

CLAIM 4 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

CLAIMED LABOR COST $

OTHER COST CLAIMED $

OTHER COST CLAIMED DETAILS

TOTAL AMOUNT CLAIMED $

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CLAIM #5

CLAIM 5 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

CLAIMED LABOR COST $

OTHER COST CLAIMED $

OTHER COST CLAIMED DETAILS

TOTAL AMOUNT CLAIMED $

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CLAIM #6

CLAIM 6 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

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OTHER COST CLAIMED $

OTHER COST CLAIMED DETAILS

TOTAL AMOUNT CLAIMED $

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CLAIM #7

CLAIM 7 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

CLAIMED LABOR COST $

OTHER COST CLAIMED $

OTHER COST CLAIMED DETAILS

TOTAL AMOUNT CLAIMED $

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CLAIM 8 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

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PART FLIGHT CYCLES

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

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OTHER COST CLAIMED DETAILS

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CLAIM #10

CLAIM 10 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

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OTHER COST CLAIMED DETAILS

TOTAL AMOUNT CLAIMED $

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

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CLAIM 12 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

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PART FLIGHT CYCLES

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CLAIM #13

CLAIM 13 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

LABOR HOURS

LABOR RATE/HR $

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OTHER COST CLAIMED DETAILS

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CLAIM 14 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

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OTHER COST CLAIMED DETAILS

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CLAIM 15 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

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OTHER COST CLAIMED DETAILS

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PART NO. *

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REASON OF FAILURE *

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REASON OF FAILURE *

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CLAIM 18 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

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PART FLIGHT CYCLES

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CLAIM 19 TYPE: *

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PART NO. *

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REASON OF FAILURE *

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CLAIM 20 TYPE: *

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REASON OF FAILURE *

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PART FLIGHT CYCLES

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CLAIM #21

CLAIM 21 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

DATE OF REMOVAL/REPLACEMENT *

PART FLIGHT HOURS

PART FLIGHT CYCLES

PART COST $

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LABOR RATE/HR $

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OTHER COST CLAIMED DETAILS

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CLAIM #22

CLAIM 22 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

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PART FLIGHT CYCLES

PART COST $

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CLAIM 23 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

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CLAIM 24 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

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CLAIM 25 TYPE: *

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PART NO. *

SERIAL NO. *

REASON OF FAILURE *

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