Rekerdres & Sons Insurance Agancy, Claims Processing System

Rekerdres & Sons Insurance Agency, inc. > Initial Notice of Damage
Initial Notice of Damage
Where damage was initially noticed:  
Your Name (person completing this form): Your Telephone Number:
Your Role is:
Policy Holder (Company Name):
Policy Holder Contact: Policy Holder Contact Email:
Commodity: Insurance Certificate:
Type of Loss: Sales/Contract Number:
Were seals intact?: Sales Invoice:
Estimated Quantity of Goods Lost/Damaged: Name of Carrier:
    B/L No.:
Container Nos. containing Damaged Goods:
Loss Description (with time and date of discovery):
Location of Damaged Goods
Located at: Location (Physical Address) of Damaged Goods:
Contact at Location: Location Country:
Contact Phone: Contact Email:
How are the goods being protected from further damage?:
Additional supporting documents? i.e. pictures, police report, outturn receipt, etc.




NB: While photos and other documents are useful - you must not delay the completion and transmission of this form.
Please type the two words: