Home
Digital Enterprise Services
Service Request Form
Digital Enterprise Services
Service Request Form
Service Request Form
Note: Old downloaded excel template will not work with this ICSSRF version V5, kindly download the latest template to upload
Download Template-
Click download button to get the valid excel template to upload.
Click here to upload a prefilled excel template of the form (Valid template only)
This template will auto populate the fields in the form.
Note: All fields marked
*
are mandatory.
Your session has been expired. Please refresh the page and send your service request again..
*
Where is the Siemens Equipment purchased from?
India
Outside India
Please select where the Siemens Equipment is purchased from.
*
Is the Product/Equipment covered under Service / Maintenance Contract?
Yes
No
*
Siemens Contract Order Number
Siemens Contract Order Number is a required field.
PO Number
Please enter only digits/alphabets. You can enter your PO Number
*
Enter IB Number
IB Number is a required field.
Please enter numeric only in Siemens Unique Equipment ID (UEID)
*
Are you the end customer?
Yes
No
*
Please define your relationship with Siemens
--Select--
Contractor / EPC
Dealer / Distributor
Ext. Service Provider
Machine Manufacturer / OEM
Siemens Sales
Siemens Service
System House / System Integrator
Relationship with Siemens is a required field.
Manufacturer/OEM (Original Equipment Manufacturer)
Manufacturer/OEM Location
A. Call logger Details
*
Salutation
Mr.
Ms.
*
Name
First Name is a required field.
Last Name is a required field.
Please enter alphabets only in First Name.
Please enter alphabets only in Last Name.
*
E-mail ID
E-mail ID is a required field.
Enter valid Email Id.
*
Contact number (Mobile)
Contact number (Mobile) is a required field.
Enter valid Contact number (Mobile)
*
Company
Company is a required field.
*
Address
Street is a required field.
*
Country
Amer.Virgin Is.
Bangladesh
Brit.Ind.Oc.Ter
Brit.Virgin Is.
Cambodia
Cayman Islands
Chad
Comoros
Croatia
Dummy entry
East Timor
El Salvador
Frenc.Polynesia
French S.Territ
Haiti
Heard/McDon.Isl
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islnds
Martinique
Mauretania
Mauritius
Mayotte
Mexico
Minor Outl.Ins.
Moldavia
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
N.Mariana Islnd
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue Islands
Norfolk Island
North Korea
Norway
Oman
Pakistan
Palau
Panama
Papua Nw Guinea
Paraguay
Peru
Philippines
Pitcairn Islnds
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Ruanda
Russian Fed.
S.Tome,Principe
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Sri Lanka
St Kitts&Nevis
St. Helena
St. Lucia
St. Vincent
St.Pier,Miquel.
Sudan
Suriname
Svalbard
Swaziland
Sweden
Syria
Taiwan
Tajikstan
Tanzania
Thailand
Togo
Tokelau Islands
Tonga
Trinidad,Tobago
Tunisia
Turkey
Turkmenistan
Turksh Caicosin
Tuvalu
Uganda
Ukraine
Uruguay
USA
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis,Futuna
Western Samoa
Yemen
Yugoslavia
Zambia
Zimbabwe
*
City
City is a required field.
Enter alphabets only in City.
*
State
--Select--
Andaman and Nico.In.
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Megalaya
Mizoram
Nagaland
Orissa
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttaranchal
West Bengal
State is a required field.
Enter alphabets only in State.
*
Pincode
Pincode is a required field.
Please enter numeric only in Pincode.
B. Type of Service Request
*
Is the Product/System covered under one of the following?
Standard product warranty
Service / Maintenance Contract
Repair Contract
EEO-Extended Exchange Option (extended warranty)
Out of Warranty/Not covered under contract
Repair/Service Warranty
Sales Warranty
*
If your product is covered under Service / Maintenance Contract, please mention the Contract reference to help us provide faster service .
Siemens Contract Order Number
Siemens Contract Order Number is a required field.
PO Number
Please enter only digits/alphabets. You can enter your PO Number
*
Type of Service Requested
--Select--
Field Service
Repair
Return/Replacement
Spare Parts
Commissioning
Training
Miscellaneous
Remote Support
Digital Services
Retrofit & Modernization
Type of Service Requested is a required field.
*
Service Priority
What is this?
o Normal
– No impact on Process or Plant
o Preventive/ Scheduled Maintenance
– Scheduled maintenance of Siemens equipments.
o Partial Breakdown
- Machine, Process or Plant is working with limited functionality, due
to malfunctioning of Siemens equipment.
o Breakdown
– Standstill condition of Machine, Process or Plant,due to non-functioning
or malfunctioning of Siemens equipment.
o Low
– For Miscellaneous.
Low
Normal
Preventive / Scheduled Maintenance
Partial Breakdown
Breakdown
Service Priority is a required field.
*
Expected Date & Time
'Expected Date & Time is required(Note: Expected Date & Time cannot be in the past).
Enter Date & Time in DD-MM-YYYY HH:MM format (e.g. 15-02-2018 23:00) (Note: Expected Date & Time cannot be in the past)
*
Short Description of the Service / Fault details (within 80 characters)
Short Description of the Service is a required field.
80
Characters Left.
*
Detailed description of the Service call request
Detailed description of the Service call request.
1000
Characters Left.
C. Point of Service Delivery / EU (Ship-to)
Check if the details are same as section A
*
Salutation
Mr.
Ms.
*
Name
First Name is a required field.
Last Name is a required field.
Enter alphabets only in First Name.
Enter alphabets only in Last Name.
*
E-mail ID
E-mail ID is a required field.
Enter valid Email Id.
*
Contact Number (Mobile)
Contact number (Mobile) is a required field.
Please enter valid Contact number : Mobile Number
*
Company
Company is a required field.
*
Address
Street is a required field.
*
Country
Amer.Virgin Is.
Bangladesh
Brit.Ind.Oc.Ter
Brit.Virgin Is.
Cambodia
Cayman Islands
Chad
Comoros
Croatia
Dummy entry
East Timor
El Salvador
Frenc.Polynesia
French S.Territ
Haiti
Heard/McDon.Isl
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islnds
Martinique
Mauretania
Mauritius
Mayotte
Mexico
Minor Outl.Ins.
Moldavia
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
N.Mariana Islnd
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue Islands
Norfolk Island
North Korea
Norway
Oman
Pakistan
Palau
Panama
Papua Nw Guinea
Paraguay
Peru
Philippines
Pitcairn Islnds
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Ruanda
Russian Fed.
S.Tome,Principe
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Sri Lanka
St Kitts&Nevis
St. Helena
St. Lucia
St. Vincent
St.Pier,Miquel.
Sudan
Suriname
Svalbard
Swaziland
Sweden
Syria
Taiwan
Tajikstan
Tanzania
Thailand
Togo
Tokelau Islands
Tonga
Trinidad,Tobago
Tunisia
Turkey
Turkmenistan
Turksh Caicosin
Tuvalu
Uganda
Ukraine
Uruguay
USA
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis,Futuna
Western Samoa
Yemen
Yugoslavia
Zambia
Zimbabwe
*
City
City is a required field.
Enter alphabets only in City.
*
State
--Select--
Andaman and Nico.In.
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Megalaya
Mizoram
Nagaland
Orissa
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttaranchal
West Bengal
State is a required field.
Enter alphabets only in State.
*
Pincode
Pincode is a required field.
Please enter numeric only in Pincode.
D. Whom should we invoice to ? (Sold-to)
Check if the details are same as section A
Check if the details are same as section C
*
Salutation
Mr.
Ms.
*
Name
First Name is a required field.
Last Name is a required field.
Enter alphabets only in First Name.
Enter alphabets only in Last Name.
*
E-mail ID
E-mail ID is a required field.
Enter valid Email Id.
*
Contact Number (Mobile)
Contact number (Mobile) is a required field.
Please enter valid Contact number (Mobile)
*
Company
Company is a required field.
*
Address
Street is a required field.
*
Country
Amer.Virgin Is.
Bangladesh
Brit.Ind.Oc.Ter
Brit.Virgin Is.
Cambodia
Cayman Islands
Chad
Comoros
Croatia
Dummy entry
East Timor
El Salvador
Frenc.Polynesia
French S.Territ
Haiti
Heard/McDon.Isl
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islnds
Martinique
Mauretania
Mauritius
Mayotte
Mexico
Minor Outl.Ins.
Moldavia
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
N.Mariana Islnd
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue Islands
Norfolk Island
North Korea
Norway
Oman
Pakistan
Palau
Panama
Papua Nw Guinea
Paraguay
Peru
Philippines
Pitcairn Islnds
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Ruanda
Russian Fed.
S.Tome,Principe
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Sri Lanka
St Kitts&Nevis
St. Helena
St. Lucia
St. Vincent
St.Pier,Miquel.
Sudan
Suriname
Svalbard
Swaziland
Sweden
Syria
Taiwan
Tajikstan
Tanzania
Thailand
Togo
Tokelau Islands
Tonga
Trinidad,Tobago
Tunisia
Turkey
Turkmenistan
Turksh Caicosin
Tuvalu
Uganda
Ukraine
Uruguay
USA
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis,Futuna
Western Samoa
Yemen
Yugoslavia
Zambia
Zimbabwe
*
City
City is a required field.
Enter alphabets only in City.
*
State
--Select--
Andaman and Nico.In.
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Megalaya
Mizoram
Nagaland
Orissa
Pondicherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttaranchal
West Bengal
State is a required field.
Enter alphabets only State.
*
Pincode
Pincode is a required field.
Please enter numeric only in Pincode.
E. Additional Information
Email 1
Enter valid Email Id.
Email 2
Enter valid Email Id.
Email 3
Enter valid Email Id.
Comments
*
500
Characters Left.
Attachments
(Please attach pictures of the fault in the equipment/ Siemens nameplate picture of the equipment)
Note: File size limit is 4MB.
Please select only .pdf, .doc, docx, .xls, .xlsx, .jpg, .jpeg, .png or .gif file.
Please select only .pdf, .doc, docx, .xls, .xlsx, .jpg, .jpeg, .png or .gif file.
Please select only .pdf, .doc, docx, .xls, .xlsx, .jpg, .jpeg, .png or .gif file.
*
Enter the text from image in the box.
Note: The code is case sensitive.
'Captcha Text' is a required field.
'Captcha Text' is invalid.
I Agree to the data privacy terms and conditions.
Data Privacy Notice
Upload File
*
Select File
Select .xls/.xlsx File
Please Select Only .xlsx or .xls File
Please mention product serial number to help us provide faster service.