DELIVERY CLAIM FORM

Dealer's Claim (Ref) No. Date of Claim YMPH Claim (Ctrl) No.

Dealer Code (Sold To) Dealer Name Outlet (Shipped To) Outlet Name

Region (c/o YMPH) DRMC No. Claim Description

NCR VIS
LZN MIN
Claim Type Affected Models Color(s) Engine(s)

Unit

Motorcycle Parts Portion (rider's L/R) Findings Qty

1. Signal Light
2. Head Light
3. Seat
4. Tail Light
5. Rear Fender
6. Muffler
7. Body
8. Others
TBA a) Wrong TBA Qty b) no lacking TBA
Should be
this model
Claimant's Name Designation

YAMAHA MOTOR PHILS, INC. - Sales Order Processing Group - 2/F Twin Oaks Place 1, #750 Shaw Boulevard Cor. Ply
Greenfield District, Mandaluyong City. TEL NO. (02) 585-1380,(0917)5654028, (02) 623-6352, (0917) 5851380 FAX NO. (02)

Defective Parts For YMPH Use Only

(date) Prepared by:

Received
 YMPH SPOS (Ctrl) No.

QCN Check (c/o YMPH)

Qty

Signature

ard Cor. Plymouth St.,

AX NO. (02) 535-2158
 DELIVERY CLAIM FORM

Dealer's Claim (Ref) No. Date of Claim YMPH Claim (Ctrl) No.

Dealer Code (Sold To) Dealer Name Outlet (Shipped To) Outlet Name

Region (c/o YMPH) DRMC No. Claim Description

NCR VIS
LZN MIN
Not yet (ETA)
(signature over printed name)
YMPH Judgment Justification Noted by:

Approved (signature over printed name)

Rejected Approved by:

(signature over printed name)

Remarks Received by:

(signature over printed name)

YMPH SPOS (Ctrl) No.

(date)

(date)

(date)

(date)