Cornerstone

Claim

Policyholder Type *

Policy Number *

Phone No *

Email Address *

Address *

City *

State *

Brief Description of Goods Carried *

Value of Goods Damaged/Lost *

If Damaged,Where They Can Be Inspected?

Origin of Transit *

Destination of Transit *

What is the Medium of Conveyance? *

Owned or Hired? *

If Medium is Vehicle, Please Specify Make and Registration No

Where Did the Incident Occur? *

Date of Incident (yyyy-mm-dd) *

Time of Incident *

Brief Description of Incident *

All Attachments Must be In PDF or JPEG Format

Upload Picture 1 *

Upload Picture 2 *

Upload Picture 3 *

Delivery Waybill/Invoice *

Statement of claim (sheet showing quantities and value of goods damaged/lost) *

Statement of Authenticity/Truth of Details Given Above (Please Tick Box). *