+ 31 10 420 8200
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First Notice of Loss Form
Important: In case of Top Urgency, please call
+ 31 10 420 8200
. Otherwise, please fill out below form as a first notification of your claim.
Please do not wait with sending this form until all information is complete. Your name, address and other data will be treated in compliance with the General Data Protection Regulation (GDPR).
At the bottom of the form, you can see in green fonts, which documents we request you to upload (if available).
Fields marked with an asterix (*) are mandatory.
Your name*
Phone number*
E-mail address*
Company name*
City
Country
-
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaidjan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island & McDonald Island
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North-Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Island
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Reunion
Romania
Russian Federation
Rwanda
Saint Martin (France)
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South-Korea
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
St. Helena
St. Kitts & Nevis
St. Lucia
St. Pierre & Miquelon
St. Vincent and the Grenadines
Sudan
Suriname
Svalbrad and Jan Mayen
Swaziland
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
The Democratic Republic of the Congo
Timor-Leste
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
United States of America
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (US)
Wallis & Futuna Islands
Western Sahara
Yemen
Zambia
Zimbabwe
Type of claim
Transport
Storage
Other
Transport type
Ship
Truck
Train
Air-carrier
Containerised transport?
Yes
No
Container nr
Has vessel been chartered via your company or and affiliate of your company?
Yes
No
Unknown
Nature of damage/short damage description
in case of more types of damages, take the most important one
-
Contamination / defilement
Delay
Sinking / Stranding / Collision
Fire damage
General Average
Heating
Infestation and Insect damage
Leakage/spill
Lost overboard
Mechanical damage
Mould damage
Off-specification
Quality problem
Rejection
Shortage
Supervision charges
Strike
Temperature claim
Theft / pilferage / embezzlement
Water damage
Unknown
Other
Any additional remarks about damage description?
Yes
No
Please describe the damage
Indication of cause of the damage
Goods/commodity
Insured quantity
Value of the goods
On which Incoterms were goods purchased
-
CIF (Cost, Insurance and Freight)
CIP (Carriage and Insurance Paid to)
CFR / C&F (Cost and Freight)
CPT (Carriage paid to)
DAT (Delivered at Terminal)
DAP (Delivered at Place)
DDP (Delivery Duty Paid)
DPU (Delivered at Place Unloaded)
EXW (Ex Works)
FAS (Free Alongside Ship)
FCA (Free Carrier)
FOB (Free on Board)
Unknown
Which company was the seller of the cargo
Do you have a certificate (or copy) of insurance document?
Yes
No
Unknown
Date of issue (or upload document)
Date of loss or discovery of loss
Place where damage was discovered
(Rough) Estimation of loss
EUR
USD
GBP
AED
AFN
ALL
AMD
ANG
AOA
ARS
AUD
AWG
AZN
BAM
BBD
BDT
BGN
BHD
BIF
BMD
BND
BOB
BOV
BRL
BSD
BTN
BWP
BYN
BZD
CAD
CDF
CHE
CHF
CHW
CLF
CLP
CNY
COP
COU
CRC
CUC
CUP
CVE
CZK
DJF
DKK
DOP
DZD
EGP
ERN
ETB
FJD
FKP
GEL
GHS
GIP
GMD
GNF
GTQ
GYD
HKD
HNL
HRK
HTG
HUF
IDR
ILS
INR
IQD
IRR
ISK
JMD
JOD
JPY
KES
KGS
KHR
KMF
KPW
KRW
KWD
KYD
KZT
LAK
LBP
LKR
LRD
LSL
LYD
MAD
MDL
MGA
MKD
MMK
MNT
MOP
MRU
MUR
MVR
MWK
MXN
MXV
MYR
MZN
NAD
NGN
NIO
NOK
NPR
NZD
OMR
PAB
PEN
PGK
PHP
PKR
PLN
PYG
QAR
RON
RSD
RUB
RWF
SAR
SBD
SCR
SDG
SEK
SGD
SHP
SLL
SOS
SRD
SSP
STN
SVC
SYP
SZL
THB
TJS
TMT
TND
TOP
TRY
TTD
TWD
TZS
UAH
UGX
USN
UYI
UYU
UYW
UZS
VES
VND
VUV
WST
XAF
XCD
XDR
XOF
XPF
XSU
XUA
YER
ZAR
ZMW
ZWL
Who is to be contacted for this matter (+phone)?
Yes
No
Unknown
Yes
No
Unknown
Name and phone surveyor (if available)
If available, please upload copies of:
Upload of document(s) and/or picture(s), max 20 MB
Confirm Humanity
Submit