Lost Goods Claim Form
Moving Company Information
Moving Company Name
Contact Person
Phone Number
Email
Customer Information
Customer Full Name
Phone Number
Email
Current Address
Moving Destination Address
Move Details
Date of Move
Move Reference Number
Claimed Lost Item(s)
Description of Lost Item(s)
Estimated Value
Quantity
Details/ Circumstances of Loss
Additional Information
Declaration
I confirm that the information provided is accurate to the best of my knowledge.
Signature
Date