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International Construction Equipment

PVE Piling & Vibro Equipment

International Dredging Specialist


Dealer Claim Form

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Dealer Claim Form

Form to be filled-in and sent within 24 hours after date of damage.

Claim data:

Name of dealer *
Claim reported by *
Customer company *
Customer representative *
Machine type *
Serial number (Without the correct serial number Dieseko Group can not accept the claim) *
Date of delivery *
Date of damage *
Date of claim *
Running hours of the machine *

Description of the claim

Describe what happened under what circumstances *
Will more/additional information follow? *
Add relevant additional information here
Add file
Do you have pictures of the damage? *
Add the pictures of the damage here
Add file

Remarks by the dealer

Place here your remarks *
E-mailadres *

Send a copy of this claim form to the following e-mail address

* = Required field
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