Fields marked with * are compulsory.
Title*
Surname*
Sales Order Number*
Tracking No. / Air Waybill No
(if known)
Date of Dispatch*
Weight of Consignment*
weight                              (kg or grams)
 
Size of Consignment*
height x width x length   (inches or cm)
 
Packaging*
(Please describe how the consignment is/was packaged)
Type of Claim*
(please choose)
 Total Loss                   Part Loss               Damage

Please provide full details of claim*
including extent of damage if applicable

 
Description of Contents*
Total current market value of missing or damaged goods*
(excluding profit margin, VAT and postage)
£
In the event of Damage or Part Loss, where can the Consignment be inspected?*
(Please enter 'Not Applicable', if this is the case)
 

CONDITIONS
I confirm that the above statements are true and I am legally entitled to payment of any claim for the lost or damaged item(s) in accordance with the Terms and Conditions under which the item(s) was/were posted. In the event of loss I also undertake to advise Same-day Dispatch Services immediately if any of the items on this form are subsequently traced and reimbursed Same-day Dispatch Services any monies paid in compensation for these items.

Signed*
(Please enter your full name)

Company Name
(if applicable)

Address*

Email*

Daytime Telephone Number*
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