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Claims
Claim Form
Claim Procedure


Claim Form
Claimant's name:
Claimant's Current Address:
Claimant's Telephone:
Claimant's Fax:
Claimant's Email:
Name of moving company that provided
the door to door service:
Address where the shipment was packed:
Address where the shipment was delivered:

Invent.
Item No.		 Article
Described
in Detail		 Nature of
Damage		 Purchase
Date
Mo./Yr.		 Original
Cost		 Replace-
ment Cost		 Amount
Claimed		 For
Adjusters
Use Only
Claimed Amount

Less Deductible

Total Amount Claimed
L
E
Where goods in storage?:         Dates:
Name and address of warehouse:
Was inspection performed: if yes, who made inspection?

Carrier    Insurance Co.    Survey Agent

The undersigned, signer of the foregoing statement, hereby makes a solemn oath to the truth of the statements contained herein and exhibits attached hereto, and that no material fact is witheld that should be included in this report. This also is to certify that I/we have not received any merchandise claimed short/missing, from any source, to date. Should I/we receive this merchandise, from any source, I/we will promptly notify MarinePack and delete the items from the claim, or if claim has been paid, I/we will return the monies paid. ALL CLAIMS MUST BE SUBMITTED TO MARINEPACK WITHIN 15 DAYS AFTER DELIVERY

       




Mailing Address: P.O. Box 284, 15476 NW 76 Ct - Miami Lakes, FL 33016
Tel: (305) 556-1488  Fax: (305) 556-3680