Damages Claim Form 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? YesNo Were details of loss/ damage noted at time of delivery? YesNo Have you notified carrier of loss/ damage? YesNo Description of items to be claimed Details of loss/damage Can the item be repaired? Amount claimed (AUD) YesNo YesNo YesNo YesNo YesNo YesNo 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.