Claim Notification

* Title: -- Mr Mrs Miss Ms Dr Prof

* Surname:

* Booking reference:

Consignment no.: (if known)

* Date of dispatch: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   2011 2012

* Weight of missing or damagedmissingdamaged item(s): -- Select -- kg grams

* Packaging: (Please describe how the consignment is/waswas packaged)

* Please provide full details of claim: (including extent of damage)

* Full description of missing or damagedmissingdamaged item(s): (product type, quantity, dimensions, serial number/s, colour etc.)

* Cost value of total consignment: £ (excluding profit margin, VAT and postage)

* Cost value of missing or damagedmissingdamaged item(s): £ (excluding profit margin, VAT and postage)

Repair cost: £ (if applicable)

Salvage value: £ (Net recoverable value after disposal costs, if applicable)

* Total amount of claim: £ (excluding profit margin, VAT and carriage)

* Where can the goods & packaging be inspected? -- Please Select -- At recipient's address At sender's address

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 to reimburse Same-Day Dispatch Services with any monies paid in compensation for these items.

* Signed: (Please enter your full name)

Company name: (if applicable)

* Address:

* Email:

* Daytime telephone number: (including area code)