Goods in Transit Claim
The issue of this form is NOT an admission of liability on the part of the Company. Please answer all questions fully and return form without delay to
ALLIANZ NIGERIA INSURANCE PLC
1
Immediate Notice Must Be Given To The Police
Policy Number
*
Name:
*
Address:
E-Mail:
*
Telephone Number
*
2
Please give the following information about your loss
Time and date of los
Location of loss
Describe fully how the loss occurred
What steps have been taken to discover the guilty person(s) and to trace and recover the stolen goods
What steps have been taken to preserve the damaged goods
Have the Police been notified
please select
Yes
No
If so, at which station
Date of notification
What are the registration numbers of the vehicles involved
State where the remaining goods can be inspected
Were the goods accompanied whilst in transit
please select
Yes
No
If so, by whom
Please state the full names and addresses of those who accompany the goods in transit
Is anybody suspected of the thef
please select
Yes
No
If so, give full particulars
Are there other insurances on the goods claimed for
please select
Yes
No
If so, give the name of the Insurer(s)
please input a tabled list of particulars of goods lost and damaged with the following table header:
I/We hereby declare that, to the best of my/our knowledge and belief, the foregoing particulars and the details given are true and correct
Signature
Date
Submit
Send Filled Content
Receivers' Email