Removalgroup claims form
Removal contractor (see booking confirmation)
Contractor 1: *
Contractor 2 (if used)
Contractor 3 (if used)

Claimant Details
Name: *
Claimant ID number: *

Email: *

Telephone number: *

Contact Address
Street: *
City: *
County: *
Postcode: *

Claim Details
Collection date: *
Delivery date: *

Please provide any additional information which you feel may
assist in the processing of your claim.

Documents to Attach
Please attach a copy of the accepted removal quotation *
Please attach a copy of the completed valued inventory form *

Please confirm that you have attached both files as required above or we cannot process your claim.
You must check this box in order to submit this form.

List of articles damaged
Please complete the schedule of damaged/missing items as fully as possible.
Guidance Notes:
- You should be made aware that an allowance maybe made for wear, tear and depreciation when determining the value of any items.
- Before a total loss can be considered in respect of an item, the possibility of repair must be investigated. You may therefore be asked to provide an independant written estimate for the repair of furniture, electrical goods etc.
- Photographic evidence of damaged items may assist in the processing of your claim. Please email/fax/post as applicable.
- Please supply a copy of any transit or contract documentation which you may have available such as signed delivery reciept. Please email/fax/post as applicable.
Description
Lost or
Damaged
Packed by
Owner/Contractor
Date
acquired
Original
cost
Replacement
cost
Repair cost or
allowance claimed