.

New Claim Onboarding Form/Quotation Request

Claim Details

Claim Name*

Claim Number*

Item/s being claims for*

Please give a brief description and quantities of item/s being claimed for.

Select or enter value

Claim value*

Please input the value as follows, if its R75 000,00. input value 75000

Date of Incident

Short Description

File Upload*

Failure to upload the correct documentation will cause a delay in the test process.

NB: Please note that if there are more than 10 attachments the additional documents need to be sent to the following address support@precisionlabs.co.za

Please use the claim name & number in the subject line.

Drag and drop files here or

Claim Received Date

Assesor/Underwriter Details

Name & Surname*

Company

Select

E-mail*

Cell Number

EG: 777 666 5555 (Please include spaces)

Office Number

EG: 777 666 5555 (Please include spaces)

Broker Details

Broker Name & Surname*

Select or enter value

Broker Company*

Broker E-mail*

Broker Contact Number*

EG: 777 666 5555 (Please include spaces)

Point of pickup*

Insured

Supplier

Broker

Insured Details

Insured Name & Surname*

Insurer C/O

Insured E-mail*

Cell Number*

EG: 777 666 5555 (Please include spaces)

Insured's Address*

Please supply full address including postal code and province. If in a rural area or on a farm also include GPS coordinates or nearest town.

Supplier Details

Contact Person Name & Surname*

Company*

E-mail*

Cell Number*

EG: 777 666 5555 (Please include spaces)

Office Number*

EG: 777 666 5555 (Please include spaces)

Supplier's Address*

Please supply full address including postal code and province. If in a rural area or on a farm also include GPS coordinates or nearest town.

Parcel Dimentions*

Please input the dimensions and weight of each parcel.

Length x Breadth x Hight & Weight EG: 30cm x 45cm x 60cm 15kg

DISCLAIMER

Take note that we make use of 3rd party Courier services, should you whish us to uplift on your behalf. We can however not take any liability to ensure that equipment is transported without any risk.

Precision Underwriters Laboratories main focus is to conduct laboratory tests in Failure Analysis, and merely offer the services of a 3rd party courier service as an option for clients to ensure the goods/equipment reach our laboratories for testing purposes.”

Invoice Details

Company*

Address

Vat Number*

Send me a copy of my responses

Privacy Notice|Report Abuse