Claim Application

If something does go wrong, we want to help you put it right. If you have a claim to make, please complete this form.

Claim Application Form (#7)

IMPORTANT NOTICE: Please complete this form fully and forward it to the relevant OMC franchise together with the required documents within 24 hours of damaged freight being dispatched/28 days of lost freight being dispatched. (Failure to submit within 14 days will result in your claim BEING automatically DECLINED)

OMC Franchise you are claiming against:

Tracking Number

I wish to claim compensation for the following goods which, while under the care of an OMC Franchisee, were:

Lost

Damaged

Other

They were sent from:

Consignor (Sender) Name:

Date Consignment Dispatched:

Consignor Address:

They were sent to:

Consignee Name:

Consignee Address:

Date OMC first notified:

Which OMC representative did you speak to:

Description of the Goods (Detailed Breakdown of goods and supplier costs net of VAT required later in this form)

Please state fully the cause/circumstances:

Amount claimed:

Please Note:

All OMC Franchisees liability ends with the obtainment of a signature from the consignee upon delivery of the goods. Also under the terms of the Contract of Carriage, carrier's liability is one of Indemnity to a maximum value of £150 (UK) and €50 (ROI) per consignment of goods as defined in the Contract of Carriage.

IMPORTANT NOTE: Your claim may automatically be declined unless all the following documents are supplied with this form:

A copy of your suppliers invoice (amount you paid) for the goods in question. (If this is not provided a replacement value will automatically ne deducted from your claim)
Photographs showing the goods, state clearly with 5% markup margin
A copy of your invoice to your customer or detailed breakdown of net price charged.
Detailed Breakdown of Goods to be completed fully and clearly in the table below:

In the case of lost goods a declaration form may also be required lo be completed by the consignee, in which case the form will be sent to the consignee by our Claims Assessor.
Important - you should not dispose of damaged property, as same may be required for inspection.
A copy of this form will be emailed to you. Please retain a copy of this form for your records.

Description of Property

Lost or Damaged

Number

of Items

Cost Price

(Cost to you,

net of VAT)

Total

Cost Price

Percentage Margin on Customer price is Manufacturers (%)

OMC Couriers Label Price (Net of VAT)

Any other details relevant to claim:

Is the Property claimed for, covered by any other policy?

Yes

If so, please provide full details of the Policy below:

Declaration to be completed by Claimant

I/We declare that the foregoing statements and particulars as so provided are true and correct in every detail.

I/We declare that I have in no manner caused the said loss or damage or by any fraud or wilful misrepresentation sought unjustly to benefit from this claim.

I/We further understand that should the original consignment arrive at a later date that same is the property of OMC Couriers who shall be notified accordingly.

Name:

Position:

Phone No:

Date:

Company:

Please tick to confirm your declaration:

Note: All questions on this form must be clearly and fully answered otherwise the investigation and processing of this claim maybe delayed untiltherequired information is supplied.

By submitting this form, you are agreeing to the declarations above.

This form will be forwarded to your nearest OMC Franchise for action.

A copy of this form will be emailed to you for your records.

File Upload- please upload all documents here to support your claim:

Choose File