Moving Damage Claim Intake Form

Intake form for household goods damage or loss claims, including shipment details, itemized loss information, valuation coverage, and arbitration program reference.

Submission Notice and Consent

• I consent to the use of this information for claim review and follow-up
• What are you reporting?
• Request anonymous submission for initial review
  If enabled, the form will limit identifying details in the initial review. A claims specialist may still need contact information later to complete the claim.

Claimant and Shipment Details

• Claimant full name
• Email address
• Phone number
• Moving company name
• Shipment or job number
• Move date
• Delivery date

Valuation Coverage and Program Reference

• Valuation coverage type
• Do you have a valuation or coverage document?
• Upload valuation or coverage document
• Include arbitration program reference in the claim review
  Use this if you want the claims team to note an arbitration or dispute-resolution program reference in the file.

Itemized Damage or Loss Details

• Claim items
• Describe the damage or loss
  Include what happened, where the item was last seen, and any visible damage. Do not include unnecessary personal data.
• Date the damage or loss was discovered

Supporting Documentation

• Photos of damage or packing condition
• Receipts or proof of value
• Additional notes