Fields marked with * are compulsory.
Type of Claim* (please choose)
 Total Loss                   Part Loss               Damage
Title*
Surname*
Booking Reference*
Consignment No.
(if known)
Date of Dispatch*
Weight of Missing or Damaged Item/s*
weight                              (kg or grams)
 
Packaging*
(Please describe how the consignment is/was packaged)

Please provide full details of claim*
including extent of damage

 
Full Description of Missing or Damaged 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 Damaged Item/s*
(excluding profit margin, VAT and postage)
£
Total amount of claim*
(excluding profit margin, VAT and carriage)
£
Where can the goods & packaging be inspected?*

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*
(including area code)
Please Enter Security Code*
(As given in grey box)