RESTITUTION FORM
Please complete this form and submit within 14 days of the last incident. Our team will review your case and be in touch with next steps.
NAME
*
First Name
Last Name
POSITION
CUSTOMER NUMBER
*
SERVING BRANCH
*
Please Select
Aberdeen
Ashford
Belfast
Bow
Camberley
Carlisle
Chester
Dublin
Dundee
Eastbourne
Grays
Hull
Inverness
Ipswich
Linwood
Londonderry
Maidstone
Newbridge
Norwich
Portsmouth
Preston
Rhyl
Ryde
SEL
Sheffield
Stockton
Wakefield
York
Not Known
TELEPHONE NUMBER
*
Please enter a valid phone number.
ADDRESS
*
Street Address
Street Address Line 2
City
State / Province
Postcode
EMAIL
*
example@example.com
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PLEASE NOTE:
We will only consider claims in the format of the table below. Claims without supporting details, or related products not supplied by InPost Distribution will not be considered. If we uphold your claim, the lost margin and/or fixed-rate HND payments will be credited to your account.
*
ISSUE DATE (DD /MM/YYYY)
TITLE
LOST SHOP SALES (£)
LOST HND SALES (£)
TOTAL LOST SALES (£)
REDELIVERED HND COPIES
1
2
3
4
5
6
7
8
9
10
Total Lost Sales (£)
RETAILER COMMENTS:
Please state the nature of your claim. Note, we may request supporting details for HND claims.
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SIGNATURE
*
PRINT NAME
*
DATE
*
-
Day
-
Month
Year
Date
Submit Restitution Request
Should be Empty: