package for delivery

Damages Claim Form

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?
 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? Amount claimed (AUD)
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
 Yes No
Total amount claimed

Please attach before photos:

Please attach after photos:

 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.