Goods in Transit Claim Form

No 2 The Colosseum Building
Century City  Boulevard

 Century City

PO Box 90 Century City 7446
Tel: (27) (21) 529 7800 
Fax: 0865 202 355
E-mail: insure@aib.co.za
 Insured
Name
Surname
Business of insured
Address
Telephone
Fax
E-mail
Policy Number
VAT Registration Number
 Details of loss or damage
Date and time of loss or damage
Description of goods concerned
Number of packages
Total Weight
How were the goods packed?
If goods were only a part of consignment, describe nature of other goods and value
Address from where goods were despatched
Date despatched
Names and adresses of consignees
Circumstances of loss or damage
Was matter reported to police? Yes    No
Details of officer/station
Date Advised
 Additional Information
If another vehicle was involved, please complete the following:
Name of owner
Address of owner
Name of insurer
Address of insurer 
Names and adresses of witnesses
 Owner
 If you are the owner of the goods, please complete this section
How and by whom were the goods transported?
Have you advised them of the loss or damage? Yes    No
Date Advised
Name and adress of their insurers
NB - Carriers should be notified of all losses without delay
 Carrier
 If you are claiming as carrier of the goods, please complete this section
Names and adresses of owners of the goods
For whom were the goods carried
Name and adress of their insurers
Were you the principle contractor, or a sub-contractor? Principle Contractor    Sub-Contractor
Registered letters and number of your vehicle concerned
If your vehicle was unattended when loss or damage occurred, how was it secured?
Were the goods in sound conditition when received? Yes    No
Were they checked by your driver? Yes    No
Did you or your employees load the vehicle? Yes    No
Did you or your employees unload the vehicle? Yes    No
Did the consignees accept delivery? Yes    No
If so, was a receipt given? Yes    No
Do you use the Standard Unicover Transport Operators Group Scheme Conditions of Carriage? Yes    No
If not, what conditions of carriage do you use? (Please send us a specimen copy)
Has a claim been made against you by the owner? Yes    No
Date Received
 Particulars of Goods Lost or Damaged
 All invoices, delivery notes, receipts and correspondence are to be sent to us
Description Quantity Value
Address where damaged goods can be inspected
 Authority for payment
It is recommended that any amount payable to you directly be transmitted by Electronic Bank Transfer for speedier settlement and security reasons.
Do you agree to this? Yes     No
 Signature
Name
Signature
Please print the completed form and fax the signed document to 0865 202 355