Report on damage to goods

Here you can send us a report on damage to goods. To do so please fill in the following fields.

Alternatively fill out the report on damage to goods form and send it to us.

Name of customer *

Street & house no. *

Postcode & Town *

Telephone number

Insurer

Insurance no.

Class of insurance*

Type of insurance

Date of damage *

Time of damage

Place of damage

Damaged/stolen goods *

Is there any other insurance cover for the goods? *

Are you entitled to input tax deduction? *

Where can the damaged item(s) be inspected? *

Name of contact person*

Telephone number

Short account of how damaged occured

Holder

Bank

IBAN

I agree that my personal data is used for the processing of my inquiry. For further information and revocation instructions see privacy policy.*

* required fields