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Goods survey
Loss Prevention
General intervention
 
 
Application form for a Loss Prevention
Fields in bold must be filled in
Applicant’s data
Name of Company Type of Company
Name of the individual Via
Phone Number Zip Code
Fax Town
E-mail Prov.
VAT number Possible notes
for invoice
Type of intervention
Urgent   Ordinary      
Object of the survey
Type of survey    
Value of the goods involved    
Type of transport
(if applicable)
   
Identification of the transport means
(number plate or data of the means,
if applicable)
   
Site of intervention
Name of the Company or site Address
Town Province
Contact Mr/Ms Phone number
Support 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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