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Goods survey
Loss Prevention
General intervention
 
 
Application form for a General Intervention
Fields in bold must be filled in
Applicant’s data
Name of Company Type of Company
Name of the individual Address
Pohen Number Zip Code
Fax Town
E-mail Prov.
VAT number Possible notes
for invoice
Type of intervention
Urgent   Ordinary      
Type of damage    
Object of the survey
Value involved
(if available)
   
Site of intervention
Name of the Company or site address
Town Province
Contact Mr/Ms Phone number
Damage documentation
Enclosed to this form    
Only annexes    
Follows by fax  fax n° +39-02-95341937    
Not currently available    
 
 
Notes and/or special instructions
 
How may we contact you? Phone   e-mail
 
 
 






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