Your personal information

Last name

E-mail address

Please provide your daytime phone number*

Order number*

Damage

When did you find out about the damages.

Did you report the damages to us earlier.
yesno

If yes, whom

Banking Details

IBAN number

For international transfers please also include following details.

Your full address

SWIFT

Name of your bank

Full address of your bank

Overview of Damages

* Inventory item: please indicate the corresponding number on the descriptive inventory.

If above not enough space please use this document or attach your own list. We kindly request you NOT to dispose of any damaged items. After receipt of the completed form we will check whether the form has been completed correctly and is provided with enclosures. When complete we will send the damage claim to our insurer. The insurer will the decide if a reimbursement will be made based on these documents or that an assessment by an expert will be necessary. For further details we refer to our General Conditions.

File with list of goods

Remarks

I hereby declare to have completed this form to the best of my knowledge. A false or incorrect claim can lead to rejection or a delay in settling the claim.

When you use this form, you agree to the storage and processing of your data through this website.