YOUR PERSONAL DATA
Fields marked with an asterisk have to be filled in.
Insurant*:
Policy number:
Address:
Are you entitled to deduct input tax?
Surname*:
First name*:
Phone no.*:
email* :
Date*:
Hour*:
During*:
Place of loss*:
German Commercial Code carrier:
Others:
Vehicle registration number of tractor*:
Registration number of trailer*::
Covered truck:
Tank truck:
Sonstiges:
Driver:
Co-driver:
Point of departure:
Date/time of departure:
Point of destination:
Date/time of arrival:
Who did the loading*?
In case of “other", name / function:
Have any agreements been made on the loading?
If so, which?
Had an acceptance by numbers been applied for?
If so, which?
Did the driver check the number upon acceptance*?
Did the driver acknowledge receipt of the number of pieces upon acceptance?
Who did the unloading?*
In case of “other“, name / function:
Has there been a transshipping*?:
Who carried the goods further on?
Have any special agreements been made*?
If so, which?
Which commodity is missing or damaged*?:
Estimated amount of loss*:
Overall weight of the commodity:
Overall weight of the damaged or lost commodity*::
Was the commodity packaged?
Type of packaging:
Did the recipient give a clean receipt*?
Where did he make reservations?
When did you discover the loss?
When have you been notified of the loss?
Where is the damaged commodity?
Which cargo surveyor had been called in and when?
Has the amount of loss already been deducted from the freight*?
Do you object against the claim?
Exact description of loss (including chain of orders):
Recorded by the police?*
File no.
Police station:
Please submit the following documents, if possible: shipping order, bill of lading, acceptance receipt in case of goods loss, notice of liability, damage account, photos of damage. Add documents:
Further documents:
Further documents:
