National claims management for carriers in the transport industry 24/7 Claim Lodgement If you are human, leave this field blank.CONTACT DETAILSFreight CompanyClaimant NameConsignment Note No.Customer Account No.Contact NameContact NumberEmailSender (Consignor)Reciever (Consignee)AddressAddressCLAIM DETAILSDate of loss/damageType of ClaimLossYesNoDate of DispatchWhere did the loss occur e.g. in transit?DamagedYesNoDate of ArrivalAddress where damaged goods can be inspectedCan damaged goods be repairedYesNoIf 'No', is there any salvage valueIf 'Yes', approximate valueDescription of goods (Please describe goods in detail)Please provide a description of the incidentAmount claimed (ex GST) $CLAIM ATTACHMENTSCopy of the Consignment NoteTax invoice for the cost price of the goodsPhotographic evidence (if damaged)Copy of the incident reportEFT PAYMENT DETAILSAccount NameBank NameAccount NumberBSBDECLARATIONI declare to the best of my knowledge all statements made in this claim form to be true and correct. All claims will be assessed based on the Warranty Cover Terms and Conditions and the Warranty fee being paid.NameSignatureReset SignatureUse your mouse to write your signatureDateCaptcha *reCAPTCHA is required.Submit If you are human, leave this field blank.CONTACT DETAILSFreight CompanyClaimant NameConsignment Note No.Customer Account No.Contact NameContact NumberEmailSender (Consignor)Reciever (Consignee)AddressAddressCLAIM DETAILSDate of loss/damageType of ClaimLossYesNoDate of DispatchWhere did the loss occur e.g. in transit?DamagedYesNoDate of ArrivalAddress where damaged goods can be inspectedCan damaged goods be repairedYesNoIf 'No', is there any salvage valueIf 'Yes', approximate valueDescription of goods (Please describe goods in detail)Please provide a description of the incidentAmount claimed (ex GST) $CLAIM ATTACHMENTSCopy of the Consignment NoteTax invoice for the cost price of the goodsPhotographic evidence (if damaged)Copy of the incident reportEFT PAYMENT DETAILSAccount NameBank NameAccount NumberBSBDECLARATIONI declare to the best of my knowledge all statements made in this claim form to be true and correct. All claims will be assessed based on the Warranty Cover Terms and Conditions and the Warranty fee being paid.NameSignatureReset SignatureUse your mouse to write your signatureDateCaptcha *reCAPTCHA is required.Submit
