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Damages Claim Form
Please fill in your details below
Job Number
Postal Address
Contact First Name
Contact Surname
Contact number
Email
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?
Yes
No
Were details of loss/damage noted at time of delivery?
Yes
No
Have you notified carrier of loss/ damage?
Yes
No
Description of items to be claimed
Details of loss/damage
Can the item be repaired?
Yes
No
Amount claimed (AUD)
Remove item
Add more items
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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Name
Email
Phone
Pick Up Address
Move To Address
Date
Preferred Time
Morning
Noon
Afternoon
Property Type
Van
1 Bedroom
2 Bedrooms
3 Bedrooms
4+ Bedrooms
Office
Commercial
Outdoor / Plants
Garage
Please
fill in your details below
Job Number
Postal Address
Contact First Name
Contact Surname
Contact number
Email
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?
Yes
No
Were details of loss/damage noted at time of delivery?
Yes
No
Have you notified carrier of loss/ damage?
Yes
No
Description of items to be claimed
Details of loss/damage
Can the item be repaired?
Yes
No
Amount claimed (AUD)
Remove item
Add more items
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.
