Embassy Exports ~ Removal Division



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Removals Division

CUSTOMER INFORMATION

Name & Surname:	Telephone Number:	E-mail Address:
Fax Number:	Mobile Number:	Your ID Number:
Name of Friend or Family Member:	Friend's Mobile Number:	Town your friend stays in:
Move Date (DD/MM/YY):
ADDRESS MOVING FROM:	ADDRESS MOVING TO:
Unit or Street Number:	Unit or Street Number
Old Street name :	New Street Name:
Old Town name :	New Town Name:
Old Province :	New Province:
SPECIAL INSTRUCTIONS:
Indicate if any Dismantling Needs:	Indicate any Special wrapping or Crating Needs:	Indicate any Other special Needs:
INSURANCE
Confirm if you need Insurance (Type YES / NO)	If YES Please specify Value of Insurance: RAND VLAUE
REPEAT CODE
~~moving~~
Repeat word exactly: