Nissan Recall Form PDF Details

For owners of 2004 to 2006 Nissan models, the discovery of an issue with the Engine Control Module (ECM) relay may lead to unforeseen repairs or replacements, posing both inconvenience and financial burden. Recognizing this, Nissan has provided a Recall Reimbursement Claim Form as a pathway for reimbursement for those who have had to pay out of pocket for these specific repairs. This comprehensive form requires the car owner to provide detailed personal information, including their name, contact details, and vehicle specifics such as model, model year, and Vehicle Identification Number (VIN). Additionally, it necessitates certification by the owner that the expenses incurred were for the repair or replacement of the IPDM (Intelligent Power Distribution Module) in relation to the ECM relay issue, affirming that these repairs were necessary and not previously compensated by Nissan. To streamline the reimbursement process, vehicle owners are instructed to supply proof of the repair and payment alongside the claim form. Acceptable documentation includes repair orders, proof of payment (such as credit card receipts or checks), and proof of ownership (like a registration or insurance proof). The completed form, alongside all requisite documents, must be mailed or faxed as directed, with the anticipation of processing within approximately 30 days from receipt of the request by Nissan. This structured process, while detailed, reflects Nissan’s commitment to rectifying the ECM relay issue for its customers and highlights the importance of clear communication and documentation in securing reimbursement.

QuestionAnswer
Form NameNissan Recall Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesNissan, Reimbursement, nissan reimbursement claim form, ECM

Form Preview Example

Nissan ECM Relay Recall Reimbursement

Claim Form

Please print clearly to avoid delays in processing.

FIRST NAME:

LAST NAME:

 

 

 

 

ADDRESS 1:

 

 

 

 

 

ADDRESS 2:

 

 

 

 

 

CITY:

STATE:

ZIP CODE:

 

 

 

DAYTIME PHONE:

EVENING PHONE:

 

 

 

 

EMAIL ADDRESS:

 

 

 

 

 

 

 

 

VEHICLE MODEL:

MODEL YEAR:

VIN:



CERTIFICATION

I (We), _____________________________________, hereby submit this form

requesting reimbursement for expenses incurred in connection with a repair/replacement of the IPDM on my MY2004-MY2006 Nissan. I certify that these repairs have been made to this vehicle and that they were not previously paid for, in whole or in part, by Nissan. I request reimbursement in the amount of $_____________. True and correct copies of documents in

support of this request are attached. I (we) understand that this document is signed under penalty of perjury.

OWNER SIGNATURE:

DATE:

CO-OWNER SIGNATURE:

DATE:

INSTRUCTIONS:

1.Please completely fill out, sign, and date this form.

2.Provide the following documents, which are required to process your request.

(Please mark out all personal account numbers on statements for your privacy.)

•Copy of REPAIR ORDER(S)

•PROOF OF PAYMENT (any one of the following):

o Copy of credit card receipt; or

o Copy of credit card statement; or o Copy of cancelled check; or

o Copy of checking account statement; or

•PROOF OF OWNERSHIP (any one of the following): o Copy of registration; or

o Copy of proof of insurance; or

o Copy of sales contract (either as the buyer or seller)

3.Mail or fax the completed form and all required documents to the following:

ECM Relay Recall Reimbursement

FAX:

(800)

791-9940

P.O. Box

677

Phone:

(800)

867-7669

Amherst,

OH 44001

 

 

 

The estimated processing time is within 30 days from the date Nissan receives

your request.

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Tips to fill in nissan reimbursement form part 1

2. After the previous array of fields is done, you have to insert the needed details in CERTIFICATION I We hereby submit, OWNER SIGNATURE, COOWNER SIGNATURE, INSTRUCTIONS, DATE, DATE, Please completely fill out sign, your request Please mark out all, Copy of REPAIR ORDERS, PROOF OF PAYMENT any one of the, o Copy of credit card receipt or o, PROOF OF OWNERSHIP any one of the, o Copy of registration or o Copy, and Mail or fax the completed form in order to go to the next step.

nissan reimbursement form completion process shown (step 2)

People who use this document often make mistakes while filling in PROOF OF OWNERSHIP any one of the in this area. Be certain to reread what you enter here.

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