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Customer Information

      Information About the Move

      Additional Information

      To ensure, we are able to consider your request for complaint, please read the information below carefully first and then answer the questions in the Damage Report Section.

      1. Please fill the form completely and provide as much detailed information as you can.

      2. Use the additional information box if you wish to provide more information or if you wish to provide information which is not covered in the questions

      3. Upload pictures of the damaged items, pictures should clearly convey the extent of the damage as well as its location on the item claimed. Provide a distance shot of the entire item with the damage visible. If necessary provide a close up picture showing the extent and nature of the damage. Please use some indicator of relative size such as a coin or a ruler. Please identify each picture and what is depicted. Unidentified pictures may delay processing of your claim. If you are submitting photographs please document your name and the item being depicted on the back.

      4. Provide Receipt/proof of purchase for damaged items and also mention manufacturer, model information and year purchased.

      Any Attachments

      (JPG, JPEG, PNG, DOC, PDF files are allowed.)

       Verified that the above replies are true to the best of my knowledge and belief and nothing untrue has been stated nor any facts have been concealed.

      Disclaimer

      • The issue of this Complaint Form is not an admission of liability on our part and is a procedural requirement. Please read our terms and conditions properly before making a claim.

      • This form is to assist the investigation process and is not a formal claim form of the insurance company.

      • All questions must be fully answered.

      • Please tick appropriately to indicate 'Yes' or 'No' answers.

      • The information provided in the form will be used in any legal disputes if may arise in future.

      • Incomplete form or incomplete information or improper pictures will not be accepted.

      *If we accept the liability of the damage, then you need to provide two repair estimates for damaged items. Estimates must clearly describe the damage, the intended repair and the cost for each repair. Repair estimates must be limited to the damage claimed.


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