Worthy New Claim

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Insured's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Hidden

Policy Begin Date

Hidden

Policy End Date

Hidden

Deductible

Submitter Contact Information

Name(Required)

First Last

Email(Required)

Phone(Required)

Loss Details

Worthy Customer(Required)

Worthy Reference No.(Required)

Worthy Transaction Date(Required)

In UK Format

Type of Loss(Required)

Date of Loss(Required)

In UK Format

Type of Loss - Other

Brief Description of Package Contents(Required)

What happened to the shipment?(Required)

Package last scanned in which city?

Package last scanned on what date?

UK Format

How were the contents secured?(Required)

Insured Value(Required)

Loss Amount(Required)

Claim Amount(Required)

Policy Limit for This Type of Shipment(Required)

Policy Limits are as follows:
FedEx is $50,000
UPS is $50,000
U.S. Express Mail is $50,000

Shipment Details

Shipping Company(Required)

Shipping Service(Required)

Tracking Number(Required)

Dispatch Date(Required)

UK Format

Expected Delivery Date(Required)

UK Format

Was shipment insured with the shipping company?(Required)

Yes

Has the shipping company reimbursed you for the loss?(Required)

Yes

How much did the shipping company pay?

Shipper Details

Who actually dispatched the shipment?

Shipper Name(Required)

From which city?(Required)

From which state?(Required)

Full State Name

Intended Recipient Details

Intended Recipient Name(Required)

To which city?(Required)

To Which State?(Required)

Full State Name

Shipping Label Details

Shipper Name / Company(Required)

Recipient Name / Company(Required)

Shipper Address(Required)

Street Address Address Line 2 City State ZIP Code

Recipient Address(Required)

Street Address Address Line 2 City State ZIP Code

Additional Information

Upload Claim Documents(Required)

Drop files here or

Max. file size: 32 MB.

Worthy Customer Invoice Worthy Security Notes Invoice(s) for Package Contents Shipping Label Photos of Shipment (if damaged/tampering) Shipping Carrier Claim Form Correspondence with Carrier Police Report (if applicable) GIA Certificate, Rolex Serial Number Details, etc. and Other Relevant Documentation

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