We regret that damages have occurred during the move of your household goods. Please read this instruction carefully before completing this form. Please fill out this form completely. We will acknowledge receipt of your claim within 48 hours.

If possible/applicable please upload a copy of the purchase receipt or a quotation of repair and (digital) pictures of the damaged items.

Your personal information

Last name*

E-mail address*

Please provide your daytime phone number*

Order number*


When did you find out about the damages*.

Did you report the damages to us earlier*.

If yes, whom

Banking Details*

IBAN number*

For international transfers please also include following details.

Your full address


Name of your bank

Full address of your bank

Overview of Damages

Description in damage
Purchase date
Purchase amount in €
Claim amount in €

* Inventory item: please indicate the corresponding number on the descriptive inventory.

If above not enough space please upload your own list. We kindly request you NOT to dispose of any damaged items. After receipt of the completed form we will check whether the form has been completed correctly and is provided with enclosures. When complete we will send the damage claim to our insurer. The insurer will decide if a reimbursement will be made based on these documents or that an assessment by an expert will be necessary. For further details we refer to our General Conditions.

File with list of goods


I hereby declare to have completed this form to the best of my knowledge. An incorrect claim can lead to rejection or a delay in settling the claim.

When you use this form, you agree to the storage and processing of your data through this website.