Dolphin Moving Claim Form

Report Damage or Loss

*Order No. :

*Claimant's Name:

Company Name:

*Phone:

*Email:

*Date of Claim:

Were your goods packed and unpacked by the moving company ?

Yes
No

Was there any external damage to the packing containers ?

Yes
No

When was the damage discovered ?

By Whom ?

Damaged/Lost Items Details

Help With Using This Form

Put your mouse over the icons to see more information. Use the "Add Note" button next to each line to add a note or comment relating to that particular file or record. Use the "Add Another Item" to request delivery of more than one file.

	Article Description	Describe Damage (missing/damaged)	Age of Item	Cost New	Current Value

(don't forget the
"*" required fields)