Service Request

Use this form to request technical support for a product problem either in or out of warranty. Refer to Signals No.SE.A-2. Received by: Hiroyuki Fukuda Date
25 Aug 2008

* Send this form by e-mail to the following address. Also attach a copy of this form to returned units. NKS area: supportnks@nkc.co.jp, NKLA area: supportnkla@nkc.co.jp, NKME area:supportnkme@nkc.co.jp, NKK area:supportnkk@nkc.co.jp, Other: supportnkc@nkc.co.jp * Fill in the following blanks except blue and yellow areas. Blue areas will be filled in by Nihon Kohden. Yellow area will be filled in by NKC. * Nihon Kohden: Head Office & Subsidiaries NKC: Head Office

Request No. NKC-0104

Contact Information Date Distributor Country Reported by Samir SIDI MAMAR E-mail Phone Fax
August 18th, 2008

Product Information Main unit model BSM-4111K Software version Installed date Shipment date ######### Invoice No. KEF30762 Distributor No Yes No RC Serial No. 01826 Language French

Med-Concept / Diagal

samir.sidimamar@gmail.com
213770935065 21321374404

Current product location Under Warranty*?

User Yes

Warranty checked by Nihon Kohden Request Type Exchange unit Other New unit

* Warranty between distributor and Nihon Kohden

Customer Information Hospital/clinic CHU Oran

Repair

Location where the problem occurred

Technical support to identify faulty unit

Problem Information (required for all Request Types) Attach image files such as display screen, recording paper, photo, etc. to the "Attachment" sheet. Attached Describe problem in detail. A white vertical band is displayed on the screen when I start up the monitor, and still present during the monitor operation. The waveforms are diplayed properly. When I have changed the LCD unit the monitor works properly.

Was there any coincident operation or phenomena when When did the problem occur? August, 2008 How often? Permanent problem the problem occurred? If other, describe it. AC power stability Grounding

Troubleshooting Information Can you reproduce the problem? If yes, how? Yes No

Do you identify a faulty unit? Yes No If yes, what is the faulty unit? How do you know? The LCD unit.I have changed it and the monitor works properly. Any questions or requests?

Rev. 2

1/9

Further check to identify a faulty unit 1. Further check required? If yes, describe check procedures Yes No Requested by: Date

Describe results of check procedure

Checked by:

Date

2. Further check required? If yes, describe check procedures

Yes

No Date

Describe results of check procedure

Date

Solution Describe cause and solution

Date 25 Aug 2008

We confirmed S/N:01826 is under the warranty period. As we arrange to ship the LCD unit(P/N:575815A) for free, please order it after filling in the necessary information at "Order Confirmation" & "Instructions for Invoice".
* NKC approval required to replace board/unit under warranty Do you agree with the above solution? If no, describe why. Yes No Approved by: Hiroyuki Fukuda

Send the following information to your NKC contact person for export Order Confirmation (for Exchange or under warranty only) P.O. No. Shipping Address Contact Person Shipment Method DL-750/2008 P.O. Date 25 Aug 2008 Diagal Sarl, Lot 3, Djenan Achabou, Dely Brahim, Algiers, Algeria Contact phone No. Hounaida Hayoula 213 213 74404 DHL or Fedex or UPS Courier Acct No. (if any)

Instructions for Invoice Unit Model Qty Remarks: 575815A 1 Description LCD unit Customs Declared Value 2000 JY

Return Information (for Exchange only) Return Authorization No. KEC No.

Rev. 2

2/9

Unit Exchange Record Inspection result Model Shipped Date Return Due Date Received Date
Repair Quality Return Normal repair -able issue Due Serial No. -able Not

Charge Regular

Before
Before

Same
Same

Before Before

Same Same

Rev. 2

3/9

Attach image files such as display screen, recording paper, photo, etc. to this sheet.

to this sheet.

This sheet is for Nihon Kohden internal use only

Customter info Request No. Date Country Hospital/clinic NKC-0104 8/25/2008 Algeria CHU Oran Product info Main unit model BSM-4111K Serial No. 01826 Softwar e

Problem Info and solution Warranty Warrant Distribtr y Type or request Yes Yes Repair

Problem Information Solution A white vertical band is displayed on the screen when I start up the monito

Order confirmation

Return info Return P.O. No. P.O. Date Authorization DL-750/2008 8/25/2008

KEC No.

Unit exchange record Shipped Model date

Return due date

Received date

Charge