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main applications - KS Motor

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MS <strong>Motor</strong> Service International GmbH (MSI)<br />

Quality Information Report<br />

for KOLBENSCHMIDT Products<br />

Customer ref. no: MSI ref. no:<br />

Your address (MSI customer): Your customer’s name (engine reconditioner, workshop):<br />

claimed part: liner cylinder head water pump oilpump<br />

Part no*:<br />

piston kit set valve fi lter camshaft<br />

rings bearing valve-guide / seat other<br />

engine-manufacturer*: engine type*: model year*:<br />

passenger vehicle bus stationary engine<br />

commercial vehicle agricultural vehicle compressor<br />

heavy duty fork lift marine-engine<br />

installation date / complete removal date / complete<br />

mileage or running time*: mileage or running time*:<br />

reason for repair /<br />

overhauling*:<br />

Have the below listed parts been overhauled (O), checked (C), replaced (R) or adjusted (A) during last overhaul?<br />

timing belt cylinder head crankshaft<br />

spark plug oil / air / fuel fi lter valve guide / seat<br />

carburettor radiator turbo charger<br />

injection pump oil- / water pump<br />

<strong>main</strong> and<br />

conrod bearing<br />

injection nozzle oil-jet nozzle small end bushing<br />

reason for claim /<br />

representation of the damage*:<br />

Please note:<br />

● In order to fi nd the fundamental cause of your damage, we need to be informed as comprehensively as possible. Please<br />

send us the entire unit i.e. piston and piston rings, piston and liner or the whole conrod or <strong>main</strong> bearing kit, including a<br />

completely fi lled in QIR (quality information report). (Address see below)<br />

● The fi elds marked with an * must be fi lled in. In order to be able to process your application faster, fi lling in of these<br />

fi elds is mandatory!<br />

● Processing will only be possible if you provide the receipt (if required with additional costs) together with this form.<br />

Receipts relating to additional costs received later cannot be taken into account offhand.<br />

● A completely fi lled in QIR (quality information report) must be provided for each component claimed about.<br />

In case of rejection, shall the parts be send back to your address? yes<br />

Charges are on your account.*<br />

city/country date signature<br />

Please return this questionnaire together with the parts to:<br />

MS <strong>Motor</strong> Service International GmbH, S-ZPT, Wilhelm-Maybach-Strasse 14, 74196 Neuenstadt, GERMANY<br />

no

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