Online damage report

Claims usually come as a surprise. What counts now is a quick response and taking the right measures.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Company name (if individual, please write “individual”)*

Division / Department (if individual, please write “individual”)*

Last Name*

First Name*

Contact #*

email*

Zip code*

Prefecture*

City/ward*

Town/number, building name*

Type of incident (fire, water, etc)*

Date of incident*

Incident location (If same, please write “same”)*

Incident detail*

Size of building (optional)

Damaged equipment name, make, model (optional)

Customer requests, etc. (inspection date, xx production line needs priority, etc.)*