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Home » Commercial Insurance » Quotes and Forms » Forms
  GOODS IN TRANSIT LOSS REPORT FORM  
     
 

PLEASE NOTE: An agent who completes a Proposal Form does so as an agent of the proposer.

It is essential that every question with * be answered fully for proper processing of the form.

For Corporate Organisation Click Here.

1.
  Surname * Surname is required.  
  First Name * First Name is required.  
  Middle Name  
  Title Please select an item.  
  Full Postal / Contact Address  
  Phone Number (s)  
  GSM Number  
  Fax Number(If available)  
  E-mail Address * Email is required.  
         
  We can send alerts to you for renewal of your policy(ies). Please confirm how you would prefer to recieve your alert.
         
Policy No: Claim No:
 

 
1
Date,time and place of loss or damage
2
State briefly how loss or damage occured
3
Date goods were collected
Date of delivery
4.
From
In Transit to:
5
Name and Address of carrier
6
If goods carried by own vehicle state:
(a) Registration mark
(b) Name of Driver
(c) Category of Driving license
(d) Total value of goods
   i) on vehicle
   ii) on Trailer
7.
(a) Was a clear receipt given by
i) The Driver?
  i) The consignee?
(b) If not how was it claused?
8. Was the conveyance of the goods subject to the condition of carriage written or otherwise?
9.
Could you please state where the remaining goods can be inspected?
10.
Were the goods accompanied whilst in transit? if so by whom?
11.
Please state the full names and addresses fo those who accopanied the goods in transit
12.
a) Is there anybody suspected of the theft?
b) If so, give full particulars
13.
Has any notice of claim been made to the Carriers or Third Parties?
14.
Has the Police been notified and if so at which station?
15.
Is there any other insurance covering the loss? If so give particulars
16.
Please give particulars of loss or damage:
 
Description of goods lost or damaged Value Salvage Amount Claimed
Total  
Please note that details of all items to be insured and their respective sums should be sent by fax or mail to our Corporate Office for further processing.
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