Goods-In-Transit Claim Form

Name *

First

Last

Address

Telephone Number

Trade/Business

Policy Number

Renewal Date

THE ACCIDENT

Extent of Journey: From - To

Date of Occurrence

Exact Location of the Accident

Particulars Of Vehicle(S) That Was Carrying The Goods:

1

Registration No.

Make

Cubic Capacity

Seating Capacity

2

Registration No.

Make

Cubic Capacity

Seating Capacity

Give Full Description Of The Cause Of Accident/Loss And The Extentof Damage To The Goods That Were Being Carried:

State the value of goods being carried

State value salvaged after the accident

Was the accident reported to the police?

If so, State Date Reported

The name of the police station

The name of the police who took the particulars

File Upload

Click or drag a file to this area to upload.

I/We declare that the above statement is true in all respects to the best of my/our Knowledge and belief and I/We undertake to give every information and assistance as the Company may require in connection with this claim