Claim Form

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Name

Company

Account Number

Phone

Job Details

Your Reference

Date Collected

Type of Goods

Quantity

Weight of Goods (kg)

Claim Details

Damage/Loss Date

Claim Notifaction Date

Description of Damaged/Missing Goods (Claimed Goods)

Weight of Damaged/Missing Goods (kg)

Please provide image proof of cost price of claimed goods.

Upload Image

Upload supported file (Max 15MB)

Consignee Name

Consignee Phone

Please provide your customer's written correspondence to you, regrading their claim for any damage or loss of goods.

Upload Image

Upload supported file (Max 15MB)

Was extra insurance taken at time of booking? *

Yes

If Yes, to what value?

Are the goods available for inspection? *

Yes

Where are the damaged goods?

Can the goods be repaired?

Yes

If Yes, what is repair value?

Is there any salvage value?

Yes

If Yes, what is salvage value?

Have you notified this claim to your insurer?

Yes

Your Insurance Broker

Broker Contact Details

Any other information in relation to this claim:

Provide Images of Damage

Upload File

Upload supported file (Max 15MB)

THE LIMITATION OF OUR LIABILITY INDER IRISH ROAD HAULAGE ASSOCIATION CONDITIONS
IS LIMITED TO €1.80 PER KILO UNLESS ADDITIONAL INSURANCE WAS PURCHASED AT THE TIME OF BOOKING

CLAIMS CANNOT BE PROCESSED WITHOUT FULL INFORMATION BEING PROVIDED AND THE SUPPORTING DOCUMENTS SUBMITTED WITH THIS FORM

ALL GOODS CARRIED SUBJECT TO OUR CONDITIONS OF CARRIAGE

NOTIFICATION OF ANY CLAIMS MUST BE WITHIN 7 DAYS OF DUE DELIVERY DATE

THE LOWER LIMIT OF LIABILITY IS €18.00 (EQUAL TO 10KGS). CLAIMS FOR AMOUNTS BELOW THIS VALUE WILL NOT BE PROCESSED

By checking the box you certify that the above information is true and correct to the best of your knowledge

I consent to having Moriarty Transport Ltd. collect the information you supply through this form. The information will be held and used by us solely for the purpose of responding to your claim and will not be retained for any other purpose.

Thanks for submitting!