BMW New Vehicle Extended Warranty Insurance

To be completed by repairerBMW New Vehicle Extended Warranty Insurance schedule number:Repairer: Accounts will not be accepted unless they include the authorisation number suppliedby Allianz.Repairer informationCompany name:Contact name:Address:Postcode:Telephone:Business telephone:Hourly labour rate: $Vehicle informationRegistration No:Vehicle make and model:Odometer reading at date of transfer:Nature of repairYear of manufacture:kmsDescription of repair:Description of rectification:Parts used:Cost:1. $2. $3. $4. $5. $Total labour hours: ______Total cost of repair (including parts and labour): $Order number:(If insufficient space, please attach any additional pages)I/We hereby declare that the above information given is true and correct.Repairer’s signature:Date:Registered repairer’s No:/ /Repair representative’s stamp30