Moving Incident Report
please complete to the fullest of your ability
CUSTOMER INFORMATION
Today's Date
*
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Month
-
Day
Year
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Protection Effective Date
*
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Month
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Day
Year
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Your Name (the Customer):
*
Your Full Address:
*
Your Daytime Phone#
*
Mover Company Name:
*
Mover's Full Address:
Storage Facility Name
if applicable, list the name of your storage facility
Storage Unit #
if applicable, list the unit number of your storage space
Storage Facility Manager Name
if applicable, list the name of the manager at your storage facility
Storage Facility Address
if applicable, list the address of your storage facility
STEP ONE
Check Your Records
Did you purchase Moving Protection? If so, confirm you have signed copy
Look at the Protection Agreement. What is the maximum limit of Liability? (enter below)
Verify that you have paid the total balance of your move
Confirm you have a signed Moving Agreement
Limit of Liability (from Step One, above if applicable)
STEP TWO
the claim
What do YOU think caused the damage to your property? (list all causes that apply)
*
Document how the damage occurred. Get photographs of all damaged property. Get photographs of the source of the damage if possible. Make detailed notes (below) of what you can see in photos, what property you see, and the type and extent of the damage to the property.
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Detailed notes for uploaded photos
When did your move take place?
*
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Month
-
Day
Year
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When did you discover the damage during the move?
*
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Month
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Day
Year
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STEP THREE
What is the Claim?
Complete the property list on the "Moving Report of Loss" form (complete separately)
Check your list against your information (photographs and notes if available).
Make sure that you have a repair or replacement receipt for each item on the claim.
Attach supporting files for Customer's Claim
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What is the total claim?
*
STEP FOUR
Was all of the damage to the property caused by one or more of the covered causes of loss?
*
Yes
No
I Don't Know
If NO, was some of the damage caused by one or more of the covered causes of loss?
Yes
No
Have you replaced or repaired the damaged property?
*
Yes
No
If Yes, Do you have receipts?
Yes
No
Attach receipts
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STEP FIVE
Finalize the file
Complete the Protected Event File with the following documents:
Copy of the signed Moving Protection Agreement (if applicable)
Customer's Moving Report of Loss
Mover's Inventory Sheet (if available)
Photographs (if available)
Attach any documents above that have not already been attached
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Final notes or comments
Submit
Should be Empty: