Vehicle Pre-Shipment Condition Report

To be completed by an independent party

Owner Details
Name

Address

in New Zealand Telephone

Overseas Telephone

Email

Shipping Details
Destination on vessel Date of shipment / /

Vehicle Details
Make of vehicle Model Year

Reg number Engine number if no reg number

Condition of tyres (including spare) Condition of upholstery/fittings

Specify any damaged glass

Battery disconnected yes ~ no (Please circle)

Radiator drained yes ~ no

Item Attached? Remarks Item Attached? Remarks

Additional lights yes ~ no Spare tyres yes ~ no

Aerial(s) yes ~ no Stereo yes ~ no

Ash trays yes ~ no make & model

Battery yes ~ no Tool Kit yes ~ no

Clock yes ~ no
List any non-standard accessories attached to the vehicle:
Floor mats yes ~ no

Hub caps yes ~ no

Keys yes ~ no

Monsoon yes ~ no List any appliances fitted in the caravan:

Odometer reading

Petrol removed yes ~ no

Household Goods & Personal Effects packed inside the vehicle are NOT COVERED

Declaration
We have inspected this vehicle and this report is our true assessment of its condition as at the date below.
Vehicle Pre-shipment

Name of Company completing this report ____________________________________________________________________________

Name of individual completing this report __________________________________________Telephone ________________________

Signature ________________________________________ Date / /

Vero Marine Insurance, an operating division of Vero Insurance New Zealand Limited VM671 11/08
PO Box 1759 Auckland Tel: +64 9 363 2600 Fax: +64 9 363 2601 www.veromarine.co.nz
Indicate on the appropriate diagram the location, type and amount of damage

Please use the following abbreviations on the diagrams

B – Bent LGC – Locked glove compartment

BR – Broken LRT – Locked rear trunk
C – Chafed M – Missing
CH – Chipped RM – Rusty metal
D – Dented S – Scratched
GC – Glass cracked SCA – Scratched and chafed all over
HDC – Heavy dust & mud covered minor defects SM – Smashed
If any, unable to determine ST – Stained
HS – Hairline scratch T – Torn
HSA – Hairline scratches all over

Any other damage or defects