Page 184 - claims information pack ebook_e

Example Claim Form
Claim Number (for internal use only) PART 2 Section E Section E
Other Losses

6) Equipment used for the reinstatement measures. Please refer to the following tables as examples of the
information requested. Templates of similar tables and spreadsheets are available to download from the
IOPC Funds website. Please provide full details on a spreadsheet and send with your claim form.

A Equipment owned (type of equipment, purchase cost and residual value, transport costs, daily rate and
period of use)

Description Residual Transport costs Period of use (days) Total
of Date of Purchase value after Daily rate Cost
equipment purchase cost use Mon Tue Wed Thur Fri
owned Delivery Return etc.
3rd 4th 5th 6th 7th
In
use
Standby
In
use
Standby
6A - Total
39

B Equipment rented/hired (type of equipment, cost of transport, cost and duration of use)

Transport costs Total
Description (if applicable) Daily hire Period of use (days) Cost
of equipment Date of hire
rented/hired rate Mon Tue Wed Thur Fri
Delivery Return etc.
3rd 4th 5th 6th 7th
In
use
Standby
In
use
Standby
6B - Total

C Equipment purchased (type of equipment purchased, cost and duration of use, cost of transport)

Description Equipment held Period of use (days) Total
of Date of Purchase Unit Resale Transport Cost
equipment purchase cost Cost value after costs in stock/issued Mon Tue Wed Thur Fri
purchased use (delivery) for use etc.
3rd 4th 5th 6th 7th
In
stock
Issued
for use
In
stock
Issued
for use
6C - Total