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?: Yes No Not Applicable 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: