a Nature of goods
Total number parcels/cartons despatched
b P
osted at
By Parcel Letter Registered
Reordered Delivery Post
c Registered/Recorded post receipt no.
Loss of
Damage to
Shortage from
d If claim for damage/pilferage has packing been kept for inspection?
e T
otal number of items missing from parcel
f Cost Price
Value of Salvage
Cost of Repairs
g Date Post Office advised
(dd/mm/yyyy)
Please attach all correspondence with Post Office, customer and copy
of invoice and compilation of claim when necessary.
£
£
£
Parcels
Parcels
Parcels
P
ost
4
Post Office
a Nature of goods
Total number parcels/cartons despatched
b National Rail National Carriers Ltd
Depot/Station Region
c Goods despatched at Boards Owner Risk
(Attach copy of Consignment Note)
d
Weight of whole consignment Value of whole consignment
e Weight of loss/damaged/ Value of affected part
pilfered part
f Loss of
Damage to
Shortage from
g Cost Price
Value of Salvage
Cost of Repairs
h Date Carriers/Railway advised
(dd/mm/yyyy)
Please attach all correspondence with National Rail/National Carriers
Ltd., customer and copy of invoice and completion of claim when
necessary
£
£
£
Parcels
Parcels
Parcels
National Rail/National Carriers Ltd
5
£
£
I/We declare the foregoing particulars to be true and complete and that I/we hold no other policy indemnifying me/us in respect of this claim.
Insurers and their agents share information with each other to prevent fraudulent claims and to decide whether to accept your proposal and,
if so, on what terms via the Claims and Underwriting Exchange Register, operated by Insurance Database Services Ltd. A list of participants
is available on request. The information you supply on this form, together with the information you have supplied on your application form
and other information relating to the claim, will be provided to participants. I/We understand that you may seek information from other
insurers to check the answers I/we have provided.
Signature Date (dd/mm/yyyy)
Declaration
6
NIG1113Q/06/15
NIG policies are underwritten by U K Insurance Limited, Registered office: The Wharf, Neville Street, Leeds LS1 4AZ.
Registered in England ans Wales No 1179980. U K Insurance Limited is authorised by the Prudential Regulation Authority
and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.
Calls may be recorded.
