Transport

Responsible person

Surname(Required)

First name(Required)

Company(Required)

Telephone number(Required)

Email(Required)

IBAN or PC number

Subject to VAT

Yes

How did the damage occur

Date of damage or when a problem was first detected(Required)

Location of damage (address)(Required)

Description of the loss event

Name/address where the goods can be inspected

Name/address of the person who caused the damage

Notes

Route

Dispatcher

Recipient

Location of dispatch/reception

Date of dispatch/receipt

By whom was it loaded/stowed/unloaded

Notes

In the case of damage at a trade fair/exhibition

Name of the trade fair

Town/city

Duration (from/to)

Police report

Has a police report been made?

Yes

If yes: Police station, date of report and officer in charge

General information

Was the damage noted on the dispatch notes?

Yes

If not, why not?

Has a letter of liability been sent to the carrier?

Did the carrier’s authorised representatives survey the damage?

Name of the carrier’s surveyor

Where are the damaged goods located?

Is there any other insurance for this loss event?

Industry and insurer

Miscellaneous

Remarks

Possible enclosuresavailable (please tick the enclosed documents)

Drop files here or

Max. file size: 5 MB, Max. files: 5.

(You can add up to five attachments here. You are welcome to submit any additional documents to schaden@verlingue.ch.)

Claim forms