Reimbursement practice management Reimbursement practice management Company Name Address Vat Number Contact Email Phone Motivation DamageLostTheftOther Name Courier Traking Shipping date (gg/mm/yyyy) Delivery date (gg/mm/yyyy) Date discovered claim (gg/mm/yyyy) Material value (€) Was the shipment insured? YesNo Additional Notes Copy of the signed LdV with reservation (Pdf or Image) Left Photograph (Pdf or Image) Copy invoice of cost of goods (Pdf or Image)
