Please fill in all the fields marked red.
 
  Claim no.:   Your unique sequential claim number
to identify this claim.
  Engine:    Turbocharger:   
 
Author
  Name:     Plant- / shipname:
  Function:
  Email:     Phone:
  Date of issue:     Date of damage:
 
Engine
  Plant:    Ship:      Engine type:
  Engine no.:     Operating hours:
       Operating hours gasmode:
Turbocharger
  TC-Ser.No.:     TC type:
       TC operating hours:
 
Damage on plant components
  Damage:
  Plant component / systems (e.g generator):
  Cylinder no.:
  Component serial no.:
  Component running hours:
  Damage type:
  Manufacturer:
  Return of parts: yes:   no:     Type of return:  
  Parts to be returned:
 
Description of damage (reason, necessary work, damage parts, briefly report)
 File to attach (eg. photography): 
 
Required Spare Parts
Quantity Spare Parts Designation Ordering Numbers