Claim Form

Kearney Moving
Local & Intra-State Claim Form

This form gives you a maximum of 3 entries. Resubmit more claims by completing another form if necessary. Any damage that you are claiming will be evaluated by our claims department and will be subject to the coverage you selected. For example: if you did not purchase full coverage for your move you will not receive full coverage. For detailed description of claims regulations click here.

Name *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Claim #1

Item Description *

Approx. weight of item *

Estimated current value of item *

Amount you are claiming on this item *

Damage Description *

Please upload up to 4 pictures of the damage you are claiming on this item.

Claim #1 - Picture A *

Max file size: 20MB

Claim #1 - Picture B *

Max file size: 20MB

Claim #1 - Picture C *

Max file size: 20MB

Claim #1 - Picture D *

Max file size: 20MB

Claim #2

Item Description *

Approx. weight of item *

Estimated current value of item *

Amount you are claiming on this item *

Damage Description *

Please upload up to 4 pictures of the damage you are claiming on this item.

Claim #2 - Picture A *

Max file size: 20MB

Claim #2 - Picture B *

Max file size: 20MB

Claim #2 - Picture C *

Max file size: 20MB

Claim #2 - Picture D *

Max file size: 20MB

Claim #3

Item Description *

Approx. weight of item *

Estimated current value of item *

Amount you are claiming on this item *

Damage Description *

Please upload up to 4 pictures of the damage you are claiming on this item.

Claim #3 - Picture A *

Max file size: 20MB

Claim #3 - Picture B *

Max file size: 20MB

Claim #3 - Picture C *

Max file size: 20MB

Claim #3 - Picture D *

Max file size: 20MB

To send this claim to the Kearney Moving claims department please press submit.

Submit

If you need to include additional items please follow the link below
Claim Form