Customer Name Address Order Number Date Shipped I confirm that goods I ordered have not been received I have checked with other members of my householdneighbours delete as applicable and ID: 259075
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NON RECEIPT OF GOODS DISCLAIMER FORM Customer Name Address Order Number: Date Shipped: I confirm that goods I ordered have not been received. I have checked with other members of my *household/neighbours (*delete as applicable) and confirm that they have not received the goods either. I agree to co - operate with the carrier’s security and/or the Police in the event of any investigation into the missing items. It is our policy to repla ce any item that is lost in post and a r eplacement item will be sent out in due course. This does not affect your statutory rights. Comments Items Not Received I believe the above declaration is true to the best of my knowledge and belief. I understand to make a false statement co uld lead to prosecution. Customer Name: Signature: (print) Claim Ref. No: (Internal Use Only)