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Kidde Claim Form

Preferred method for submitting BULK claims is to use the claims template on the main warranty page.

Customer Name

Customer Number

City

State

Country

Submitter Name

Phone

Claim Number

Purchase Order/Repair Order

Contract Applied

Letter of Delegation on File

Removal: A/C Type

Removal: A/C Serial #

Removal: A/C Tail #

Original Fit: A/C Type

Original Fit: Serial #

Original Fit: Tail #

Manufacturer's Part #

Old/Removed Serial #

New /Installed Serial #

Parts: Part Number

Parts: Quantity

Parts: Price per Unit

Parts: Total Amount

Date of Failure

Date of Repair

Complaint

Corrective Action

Notes