The undersigned does hereby swear or affirm that all entries made in this Statement of Claim and contained in the attached supporting documentation are true and correct to the best of my knowledge and belief and constitute my complete and entire claim growing out of or in any way connected with the transportation or storage of my possessions. The undersigned does further swear or affirm that there have been no material facts relative to this claim that have either been withheld or misrepresented. The undersigned does hereby agree that if it is determined by Great Movers LLC, that any of the above information or supporting documentation is false, or that material facts have been withheld, then this shall justify the denial of my claim by Great Movers LLC.

E-Signature. Please enter your signature to verify the above statement. In making this claim, you must be prepared to justify the value you have placed on the lost or damaged articles. Remit any documents which would be required in support of your claim. This form must be signed by the claimant who is the owner of all items claimed to be lost or damaged. Once this claim form is submitted no further claims may be made against Our Company.