Claim-Nr. Insurance:
Claim-Nr. RVM:
Insurance Company:
Damage Report for:
Marine Insurance - Pol. Nr.:
Fowarder’s liability insurance - Pol. Nr.:
Policy Holder:
Name:
Place:
Contact Person:
(Name/ No. )
Damage Descritption (ishort form):
Consigner:
Consignee:
Forwarder / Carrier:
Mode of Transport (by truck, ship….):
Date of Damage:
Damaged Goods / Quantity:
Probably Amount of Loss:
ca. Euro
Exists a Notice of Liable?
If so, when the forwarder/carrier was held liable?
Where are the Damaged Goods ?
(If the amount was higher then EUR 2.500 please send us
currently the adress and the phone no. of the contact
person )
Documents required
1. Claim Invoice :
attached
not exists
2. Commercial Invoice:
attached
not exists
3. Transport Order:
attached
not exists
4. CMR / Bill of Lading / P.O.D.:
attached
not exists
5. Delivery Note / Packing List:
attached
not exists
6. Damage Protocol
attached
not exists
7. Unloading Report:
attached
not exists
8. Notice of Liable / Correspondency:
attached
not exists
9. Certificate of Insurance:
attached
not exists
10. Other Documents:
attached
not exists
Send Email to:
Place , Date
[email protected]
Signature
RVM Raiffeisen-Versicherungsmakler GmbH • A-4020 Linz • Europaplatz 1a • Tel.: +43(0)732/6596 25651 • Fax: +43(0)732/6596 25653 Büro Linz: Blumau Tower • Büro Wien:
A-1010 Wien • Operngasse 2 • Tel.: +43(0)1/796 9823 25941 • Büro Salzburg: A-5020 Salzburg • Rudolfskai 50 • Tel.: +43(0)662/843577 19101 • e-mail: [email protected] • DVR:
0909572 • FN 157776 z Firmenbuchgericht: Landesgericht Linz UID Nr.: ATU44793103 • Bankverbindung: Raiffeisenlandesbank OÖ • IBAN AT72 3400 0000 0011 1104 BIC:
RZOOAT2L
•
www.rvm.at
•
Versicherungsmakler
und
Berater
in
Versicherungsangelegenheiten
•
Gewerberegisternummer
40121827