UNIRISC

CLAIM PACKET

We hope your relocation goes well and wish you the very best in your new home.
Please do not hesitate to call on us if we can be of any assistance.

UNIRISC
 All personal information that comes into the
possession of UNIRISC is treated as confidential and
protected as such. No customer personal information
will be disclosed either orally, electronically, or in a
written format to anyone that is not authorized to have
this information. This information is retained by
UNIRISC only for the purposes of either placing
coverage on your goods for your relocation, or
handling your claim as a result of your relocation, and
only during the course of either of these activities.
For EU citizens, should you not consent to this,
please notify us of this fact right away.
 INSTRUCTIONS FOR MANUALLY
COMPLETING AND FILING A UNIRISC CLAIM FORM

IMPORTANT – GENERAL CLAIM INFORMATION

Your claim should be a statement of all loss and/or damage resulting from your move. Please make sure you have
unpacked all cartons and checked all furnishings for damage before you submit your claim.
• You may file only one claim per shipment
• ALL CLAIMS SHOULD BE FILED AS SOON AS POSSIBLE AFTER YOUR MOVE. ALL CLAIMS
MUST BE RECEIVED BY UNIRISC WITHIN 100 DAYS FROM THE DATE OF DELIVERY.
CLAIMS RECEIVED PAST THIS TIME FRAME WILL BE DENIED.
• Claims for damages to your residence (walls, floors, shrubs, etc.) must be referred to the moving company.
Please forward such claims directly to them for processing.
• DO NOT DISCARD ANY ITEMS: ALL DAMAGED ARTICLES, INCLUDING ITEMS THAT ARE
DAMAGED BEYOND REPAIR, MUST BE KEPT FOR INSPECTION BY THE ADJUSTER. FAILURE TO
HAVE THESE ARTICLES AVAILABLE WILL RESULT IN THE CLAIM BEING DENIED. The insurance
company may claim any damaged articles, which are replaced, for salvage.

Please forward anything else you feel relevant for supporting your claim, receipts, pictures, appraisals, etc.

Please complete your claim form with the following information. Missing information may delay your
claim processing. Please remember to include your Cartus file number.

Inventory Number - Enter the item number from the mover’s inventory that corresponds to the article damaged or lost.

Description of Article - Identify each item including its brand name, if applicable (i.e.: Ethan Allen dresser, Schwinn
Imperial bicycle).

Nature and Extent of Damage - Describe in detail (i.e.: right leg scratched, left arm rubbed and chipped, picture tube
broken, etc.)

Replacement Cost - Enter the cost of replacing this item with like kind and quality.

Date of Purchase - List the date item was purchased. If the item was a gift, list the date it was given to you.

Amount Claimed – You must enter an amount you are claiming as compensation for every item. If you prefer an item
be repaired, do not enter an amount, instead write “repair” in this column. Keep in mind that the insurer has the right to
repair rather than replace damaged articles. Please attach any receipts, estimates, etc. which will assist in validating the
claim.

Missing Items – If items are claimed missing, a copy of the inventory with written exceptions taken at delivery, and
signed by the driver must be submitted along with the claim form. If you report a carton MISSING, itemize the contents,
including the date of purchase and replacement cost for each article. Also include anything you have that may help
substantiate value and ownership; i.e. purchase receipts, canceled checks, credit card receipts, etc. In submitting this claim
you are certifying that the copies of the inventories attached, inclusive of all notations, signatures and exceptions were
executed at the time of delivery, in the presence and with the knowledge of the moving personnel / driver.

Automobile – If your vehicle was transported in the moving van/container with your household goods, please utilize this
form for claiming any damages. An estimate and the destination vehicle condition report must be submitted for the claim
to be considered. If your vehicle was moved via a car carrier, any claim must be directed to them for processing.

If available, please include copies of the carrier’s Bill of Lading.

Claims may be faxed, mailed, emailed or completed online. Send the original to: The UNIRISC office responsible for
processing your claim. Please refer to the Map for the address of the appropriate UNIRISC office. Please keep a copy
for your records.
 INSTRUCTIONS FOR SUBMITTING A
UNIRISC CLAIM FORM ON-LINE

• Please access the UNIRISC website at: www.unirisc.com

• On the UNIRISC Home page, click the “SUBMIT CLAIM” button
• Under Account Login enter your EMAIL ADDRESS
• Enter a PASSWORD for your account
• Click “REGISTER” (you may only register 1 time)
• Complete the “CREATE A NEW ACCOUNT” information
• Enter (RC5699) for the COMPANY CODE
• Again, enter whatever password you have chosen and confirm it
• Click “REGISTER AND SIGN IN NOW”
• You will be taken back to the Home page where you will click on the “CLAIM FORM”
button on the top middle of the page
• Please proceed with entering your claim following the directions given. Missing information
may delay you claim.

FILING A SUPLEMENTAL OR FUTURE CLAIM:

(Please note only one claim per shipment is allowed with the exception of emergency claims)

• Access the UNIRISC website and click submit a claim.

• Under Login ENTER YOUR E-MAIL ADDRESS

• FOR PASSWORD, enter the password you chose when you first registered on the site. If
you do not recall your password, kindly click on “FORGOT PASSWORD” and a will be
sent to you containing it.
 CLAIM FILING MAP
Use the map below to determine which UNIRISC office will be responsible for handling your domestic claim
within the 48 contiguous United States. If your destination state is highlighted in blue, please file your claim
with the UNIRISC NJ office. If you destination state is highlighted in green, please file your claim with the
UNIRISC Texas office. Please see below for moves outside the 48 contiguous United States.

UNIRISC TEXAS UNIRISC NEW JERSEY

800 E. Campbell Road, Suite 123 80 West Century Road, Suite 301
Richardson, TX 75081 Paramus, NJ 07652
Phone: 972-702-0557 Phone: 201-967-7810
Fax: 972-702-0573 Fax: 201-967-7110
txclaims@unirisc.com njclaims@unirisc.com
Mgr.: Kim Provo Mgr.: Denice Valluzzi

All moves to Puerto Rico, Mexico, Hawaii, Alaska and Virgin Islands: Send claims to Texas office
All outbound international moves: Send claims to Texas office
All Canadian provinces: Send claims to Texas office

Notes on Claim Form:

1. Complete claim form, excluding the shaded areas
2. Inventory No.: locate the damaged or missing item on the mover’s inventory, and list the number assigned to it.
3. Description of article: identify each item and include the brand name (if applicable).
4. Nature and extent of damage: Describe in detail, i.e. right leg broken, or top chipped.
5. Date of purchase or cost: List date of purchase and the cost of replacement. If a gift, list date received, and estimated cost.
6. Enter an amount claimed, or if you feel the item is repairable, leave this space blank. UNIRISC will send representatives to repair and/or estimate the
damage (or request that you obtain an estimate). You will not be reimbursed for estimate fees unless said estimates are requested by UNIRISC.
7. Include copies of all moving documents with the claim form.

CARTUS (03/2021)
 CARTUS / RC-5699 Statement of Claim
Cartus File Number:

Customer Name Origin – City and State Pick Up Date: Delivery Date:

Full Street Address Name of Moving Company / Van Line: Carrier Reference Number:

Address: (typically found in the upper right hand corner of the moving company’s paperwork)

City, State, Zip:

Home Phone Number: Work Phone Number: Mr.

Mrs.

Cell Phone Number: Email Address:

FAILURE TO COMPLETE ANY OF THE BOXES ABOVE
MAY CAUSE A DELAY IN THE PROCESSING OF YOUR CLAIM For Office Use Only
REPLACEMENT DATE OF AMOUNT INITIAL APPROXIMATE AMOUNT CARRIER EXCESS
INV. NO DESCRIPTION OF ARTICLE NATURE AND EXTENT OF DAMAGE
COST PURCHASE CLAIMED PAYMENT WEIGHT ALLOWED LIABILITY LIABILITY
*

IF ITEMS ARE CLAIMED AS MISSING A COPY OF THE INVENTORY WITH WRITTEN EXCEPTIONS TAKEN AT DELIVERY, AND SIGNED BY THE DRIVER MUST
BE SUBMITTED. I CERTIFY THAT THE COPIES OF THE INVENTORIES ATTACHED, INCLUSIVE OF ALL NOTATIONS, SIGNATURES, AND EXCEPTIONS, WERE
EXECUTED AT THE TIME OF DELIVERY, IN THE PRESENCE AND WITH THE KNOWLEDGE OF THE MOVING PERSONNEL / DRIVER: 0
I am the owner of the property described. I did not cause or contribute to the damage set forth herein.

All Statements made in this Statement of Claim and any attached documents are true and correct to the best of my
*All items must have claimed amount unless you prefer that an item be
knowledge and belief, and constitute my complete and entire claim. No material information has been withheld. repaired in which case please write “repair” in the amount claimed area.

I hereby assign and transfer to UNIRISC any and all claims and recoveries arising out of the shipment of my household goods.
For international claims, please state the currency you would like to be paid
Any persons who knowingly and with the intent to defraud any insurance company or other person, files an application in:________________________
for Insurance or statement of claim containing materially false information or conceals for the purpose of misleading
information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects PLEASE ATTACH COPIES OF:
the person to criminal and civil penalties.
1) Bill of Lading and any other documents from the mover.
2) Any bills of sale, appraisals, estimate or other documentation substantiating
amount claimed for damaged items and value for missing items.

Signature Date