{"id":15063,"date":"2022-11-11T18:00:29","date_gmt":"2022-11-11T17:00:29","guid":{"rendered":"https:\/\/www.checkstar-techblog.it\/?page_id=15063"},"modified":"2025-11-04T09:29:13","modified_gmt":"2025-11-04T08:29:13","slug":"application-for-reimbursement-intervention-guarantee-form-2","status":"publish","type":"page","link":"https:\/\/www.checkstar-techblog.it\/en\/forms\/application-for-reimbursement-intervention-guarantee-form-2\/","title":{"rendered":"Warranty Claim Form"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_15' style='display:none'>\n                        <div class='gform_heading'>\n\t\t\t\t\t\t\t<p class='gform_required_legend'>\"<span class=\"gfield_required gfield_required_asterisk\">*<\/span>\"indicates required fields<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_15'  action='\/en\/wp-json\/wp\/v2\/pages\/15063' data-formid='15' novalidate data-trp-original-action=\"\/en\/wp-json\/wp\/v2\/pages\/15063\"> \r\n <input type='hidden' class='gforms-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/>\n                        <div class='gform-body gform_body'><div id='gform_fields_15' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_15_6\" class=\"gfield gfield--type-text gfield--width-half gf_readonly gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_6\" ><label class='gfield_label gform-field-label' for='input_15_6'>Login<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_15_6' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_15_3\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_3\" ><label class='gfield_label gform-field-label' for='input_15_3'>MM Code<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_15_3' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_15_1\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_1\" ><label class='gfield_label gform-field-label' for='input_15_1'>Repair Centre Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_15_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_15_4\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_4\" ><label class='gfield_label gform-field-label' for='input_15_4'>Name of Spare Parts Dealer<\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_15_4' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_15_8\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_8\" ><label class='gfield_label gform-field-label' for='input_15_8'>Contact person for the request<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_15_8' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_15_41\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_41\" ><label class='gfield_label gform-field-label' for='input_15_41'>Workshop name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_41' id='input_15_41' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_15_19\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_19\" ><label class='gfield_label gform-field-label' for='input_15_19'>Email for confirmation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_19' id='input_15_19' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_15_18\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_18\" ><label class='gfield_label gform-field-label' for='input_15_18'>Phone<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_18' id='input_15_18' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_15_50\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_50\" ><label class='gfield_label gform-field-label' for='input_15_50'>Service Area Manager<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_50' id='input_15_50' class='large gfield_select'  aria-describedby=\"gfield_description_15_50\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select a Service Area Manager<\/option><option value='Donadio Raffaele' >Donadio Raffaele<\/option><option value='D&#039;Onofrio Giovanni' >D'Onofrio Giovanni<\/option><option value='Falcicchio Gianluca' >Falcicchio Gianluca<\/option><option value='Garagozzo Andrea' >Garagozzo Andrea<\/option><option value='Garbin Marco' >Garbin Marco<\/option><option value='Mancini Mirko' >Mancini Mirko<\/option><option value='Novara Giorgio' >Novara Giorgio<\/option><option value='Scognamiglio Luca' >Scognamiglio Luca<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_15_50'>This form will also be sent to the e-mail address of the selected SAM<\/div><\/div><div id=\"field_15_10\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_10\" ><hr style=\"color: var(--bs-blue);\">\n<h5>Reimbursement is requested for work carried out on the following equipment under warranty:<\/h5><\/div><div id=\"field_15_27\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_27\" ><label class='gfield_label gform-field-label' for='input_15_27'>Model<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_15_27' type='text' value='' class='large'    placeholder='Indicates equipment' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_15_42\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_42\" ><label class='gfield_label gform-field-label' for='input_15_42'>SN<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_42' id='input_15_42' type='text' value='' class='large'    placeholder='Serial number' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_15_37\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_37\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Operations performed<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_15_37'>Labour time in brackets<\/div><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_15_37'><div class='gchoice gchoice_15_37_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.1' type='checkbox'  value='30'  id='choice_15_37_1'   aria-describedby=\"gfield_description_15_37\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_15_37_1' id='label_15_37_1' class='gform-field-label gform-field-label--type-inline'><strong>(30')<\/strong> Cleaning solenoid valves and check valves<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_15_37_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.2' type='checkbox'  value='15'  id='choice_15_37_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_37_2' id='label_15_37_2' class='gform-field-label gform-field-label--type-inline'><strong>(15')<\/strong> Calibration of all scales<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_15_37_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.3' type='checkbox'  value='30'  id='choice_15_37_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_37_3' id='label_15_37_3' class='gform-field-label gform-field-label--type-inline'><strong>(30')<\/strong> Replacement of compressor or vacuum pump<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_15_37_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.4' type='checkbox'  value='30'  id='choice_15_37_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_37_4' id='label_15_37_4' class='gform-field-label gform-field-label--type-inline'><strong>(30')<\/strong> Replacement of pressure gauges<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_15_37_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.5' type='checkbox'  value='60'  id='choice_15_37_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_37_5' id='label_15_37_5' class='gform-field-label gform-field-label--type-inline'><strong>(60')<\/strong> Replacement of logic board and calibration of all scales<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_15_37_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.6' type='checkbox'  value='30'  id='choice_15_37_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_37_6' id='label_15_37_6' class='gform-field-label gform-field-label--type-inline'><strong>(30')<\/strong> Printer replacement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_15_37_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.7' type='checkbox'  value='10'  id='choice_15_37_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_37_7' id='label_15_37_7' class='gform-field-label gform-field-label--type-inline'><strong>(10')<\/strong> Quick coupling replacement<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_15_37_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.8' type='checkbox'  value='30'  id='choice_15_37_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_37_8' id='label_15_37_8' class='gform-field-label gform-field-label--type-inline'><strong>(30')<\/strong> Diagnosis and final testing<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_15_37_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_37.9' type='checkbox'  value='0'  id='choice_15_37_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_15_37_9' id='label_15_37_9' class='gform-field-label gform-field-label--type-inline'>More<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_15_45\" class=\"gfield gfield--type-number gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_45\" ><label class='gfield_label gform-field-label' for='input_15_45'>Time other operation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_45' id='input_15_45' type='number' step='any'   value='' class='large'    placeholder='in minutes (number only)' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_15_43\" class=\"gfield gfield--type-text gfield--width-two-thirds gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_43\" ><label class='gfield_label gform-field-label' for='input_15_43'>Other operation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_15_43' type='text' value='' class='large'    placeholder='Description' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_15_46\" class=\"gfield gfield--type-number gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_46\" ><label class='gfield_label gform-field-label' for='input_15_46'>Overall time<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_46' id='input_15_46' type='number' step='any'   value='' class='large'    placeholder='Enter the sum of operations in minutes (number only)' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_15_51\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_51\" ><label class='gfield_label gform-field-label' for='input_15_51'>Additional notes<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_51' id='input_15_51' class='textarea small'    placeholder='Specify special conditions here (different prices, deferments, etc.).'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_15_11\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_11\" ><hr style=\"color: var(--bs-blue);\"><\/div><div id=\"field_15_35\" class=\"gfield gfield--type-html gfield--width-quarter gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_35\" ><label class=\"gfield_label\" >Date<\/label><br>30\/04\/2026<\/div><div id=\"field_15_17\" class=\"gfield gfield--type-text gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_17\" ><label class='gfield_label gform-field-label' for='input_15_17'>Place<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_15_17' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_15_49\" class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_49\" ><div class=\"card p-2\">\n<table class=\"table\">\n  <tbody>\n    <tr>\n      <th scope=\"col\" colspan=\"2\">Space reserved for Marelli Aftermarket SpA:<\/th>\n    <\/tr>\n    <tr style=\"background-color:#DCE6F2\">\n      <td>Forfeit station recovery under warranty<\/td>\n      <td class=\"col-4\">\u20ac<\/td>\n    <\/tr>\n    <tr style=\"background-color:#DCE6F2\">\n      <td>Total labour<\/td>\n      <td>\u20ac<\/td>\n    <\/tr>\n    <tr style=\"background-color:#B9CDE5\">\n      <td><strong>Total amount<\/strong><\/td>\n      <td><strong>\u20ac<\/strong><\/td>\n    <\/tr>\n  <\/tbody>\n<\/table>\n<table class=\"table\">\n  <tbody>\n    <tr>\n      <th scope=\"col\" colspan=\"2\">Data to be indicated by the customer on the invoice:<\/th>\n    <\/tr>\n    <tr style=\"background-color:#4F81BD;color:#ffffff\">\n      <td>Purchase order to be mentioned by the customer in his invoice vs. MM<\/td>\n      <td class=\"col-4\">n.<\/td>\n    <\/tr>\n    <tr style=\"background-color:#4F81BD;color:#ffffff\">\n      <td>RMA<\/td>\n      <td>n.<\/td>\n    <\/tr>\n  <\/tbody>\n<\/table>\n<\/div><\/div><fieldset id=\"field_15_9\" class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_15_9\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_9.1' id='input_15_9_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_15_9\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_15_9_1' >I have read and agree to the site's Privacy Policy.<\/label><input type='hidden' name='input_9.2' value='Ho letto e sottoscrivo la Privacy Policy del sito.' class='gform_hidden' \/><input type='hidden' name='input_9.3' value='12' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_15_9'>Marelli Aftermarket Italy S.p.A., owner of the processing of your personal data, pursuant to art. 13 Legislative Decree 30.06.2003 no. 196 (privacy code) informs you that the personal data provided during contractual, commercial and promotional relations are subject to computer or paper processing for legal obligations for the purposes of market analysis and statistics. 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