Your Name
*
First Name
Last Name
Policy Number
This can be found on your policy schedule.
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: 00000000000.
Your Address
*
Street Address
Street Address Line 2
City
State / Province
Post Code
Claim Type
*
Loss
Theft
Damage
Incident Date
*
-
Day
-
Month
Year
Date
Total value of goods in transit
*
Estimated claim value
*
Collection Address
*
Street Address
Street Address Line 2
City
State / Province
Post Code
Delivery Address
*
Street Address
Street Address Line 2
City
State / Province
Post Code
Who is the cargo owner?
*
Who was carrying the goods at the time of the incident?
*
Description of what happened
*
Crime Reference Number (if applicable)
Photos of Damage
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Evidence of value (Purchase Receipts, Repair Invoice e.t.c)
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Packing List
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This is a document produced before the move to show the goods being transported, the packing details and weight of each item
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Commercial Invoice
*
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This is a document that explains what you’re shipping and how much it’s worth.
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Consignment Note
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This is a document for goods being transported by road, which notes the contract of carriage and includes the instructions given to the carrier and the terms agreed.
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Freight Invoice
*
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The invoice you charged to move the goods.
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If you were not the carrier at the time, please upload evidence you have held the carrier liable
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Signature
*
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