Damages Claim Form

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Job Number

Postal Address

Contact First Name

Contact Surname

Contact number

Date of loss/damage

Goods moved from

Goods moved to

When was loss/damage first discovered?

Please provide details of the loss/ damage incident?

Were goods professionally packed? YesNo

Were details of loss/damage noted at time of delivery? YesNo

Have you notified carrier of loss/ damage? YesNo

Description of items to be claimed

Details of loss/damage

Can the item be repaired? YesNo

Amount claimed (AUD)

Total Amount Claimed

Please attach before photos

Please attach after photos

Declaration

I declare that to the best of my knowledge and belief the information in this form is true and correct and I have not withheld any relevant information. I understand that Insurers do not admit liability by the issue of this form.

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Total Amount Claimed

Declaration

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Total Amount Claimed

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