5207H_ASC Plan Leaflet_?'' x 9.25'_0pen 34.3' x 9.

25"_Front

DAIKIN THE WORLD"S N0.1 AIRCONDITIONING COMPANY FROM JAPAN

5207H_ASC Plan Leaflet_?'' x 9.25"_0pen 34.3" x 9.25"_Back

Non
169*Scheme
(Non
I I
Non Comprehensive)
Comprehensive I Co>mpn>h<>nslvel Labour Only Labour Only

""'' Non Non Application Form-cum-Receipt No.: Non Non Application Form-cum-Receipt No.:

-••
hem Comprehensive hem Comprehensive Item Comprehensive hem Comprehensive
Comprehensive I would like to maintain my Air Conditioner through Dalkln's Annual Service Care Plan for which I give below the following detail$: Comprehensive I would II keto maintain my AlrCondltlonerthrough Dalkln's.Annual Ser.olce Care Plan lor which I give l:lelow the following details:

3,700 3,000 1,500 3,000 2,300 1,200 2,024 169

I Compressor y., No Plastlc/Thennocol Items No No
A Personal Details
Compressor Yos No Plastic!Thermocolltems No No
A Personal Details

I Fan Motor Yos Yos Sheet Metal Parts No No Fan Motor Yos Yos Sheet Metal Parts No No

I y., P:C.B. Yos Yos Remote Controller Qf broken) No No

•
P.C.B. Vee Remote Controller (If broken) No No

I Magnetic Switch y., y., Circuit Breaker No No Magnetic Switch Yos Yos Ci11<uit Breaker No No

II --
Transformer Ye• v.. Condenser & Evaportator Coils No No Transformer Yes Yes Condenser & Evaportator Colis No No
4,600 3,600 1,800 3,700 2,700 1,400 2,376 198

-
Refrigerant y., Yos Refrigerant Yos Yos Voltage Stabilisers & Scanners

4 RMS*J2RMS~ v.. v.. Any damage due to rodents,

msects, etc. '"""
PIN PIN
• Annual Service Care period: from ______ to ______ C. Payment Details C. Payment Details
5,500 4,000 2,000 4,500 3,000 1,500 2,6-40 220
::LJL:J
Phone Resldenae Phone Resldenae
• Prices of Annual Service Care Contracts: Off..
Mobile
::L]c:J Flon mid after pajmerll ....i..tian
oeoo
Motlile Flon mid after payment raali..tian

..
OW<;HEQI,IE NO. OWCHEQI,IE DATE OI>ICHEQI,IE NO. DDICHEQUE DATE

IDU/ODU Model Serial No. Date of Purchaae Total Amount

IDU/ODU Model Serial No. Date af Purchaae Quantity
"""' Total Amount E-mail
, .... OOI'In-01
DaJ~n"'""'"""'""''~~'""'"Pwt. Lt<l
,
Quantity
"""" E-mail
,_OO!'Infl.\1001'0!
DaJ~nAJ""""'"""''~~'""'"""- Lt<l
NAME OF THE BANK NAMEOFTI-iEBANK
6,000 4,000 2,000 5,000 3,000 1,500 2,640 220

D. Declaration by applicant D. Declaration by applicant

I hEMI rood ond und&llllood the term• and con<ltlono <JI the Doll<ln Annual S.rvlco car.. Flan mentioned I hEMI read md under81ood the term• and condition• of tha Doll<ln Annool Sorvlo& Core Flan mantlonad
.aewhere illhis dowment..,d agoee to abide by the ....,., elsewhEre in this dooumenl and "'l"'e to abide by the .,.., •.
SignaUJ"' (Customer) Signatu"' (Customer)

6,500 5,000 2,500 5,300 3,800 1,900 3,344 279 E. Paymant r1:100ivGd by Sarvioo Engineer E. Paymant r1:100ivGd by Service Engineer
Total
Total
En~inBBrNema En~inBBr Nama
VATIWCTfJJ
YAT/WCf@
Aulhori""d Service Authclri~ed Ser.oice
Provider
Service Tax@ Provider
Service Tax@
Any Other Taxes (if applicable)@
Any Other TaXes (If applicable}@
11,700 9,500 4,500 9,500 7,300 3,400
Signat<re (Receiver) Signature (Rocoivet1

F. To be filled by Dalkln Authorised Servloe Provider F. To be filled by Dalkln Authorised Servloe Provider

Declanrtlon by Servloe Provider: I have Inspected the appllanc:e{s) and nnd llflhem to be In good working condition. Declarafton by Servloe Provider: I have Inspected theappllance(s) and find llflhem to be In good working condlfton.
ln~pactad
Signat<re Signature
14,000 11,500 5,500 11,300 8,800 4,200
"' CUSTOMER COPY SERVICE PROVIDER COPY