Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Order Date *

MM

DD

YYYY

DECLARATION *

• I wish to deny receipt of the above Order and confirm that I have checked with those within my household and/or neighbours that may have signed for the Goods. • I will inform you immediately if it arrives. • I agree to co-operate with the shipping company regarding this matter and report it to the police if appropriate. • If the matter is reported to the Police, I am willing to assist them in this matter. • I will provide an accurate telephone number and co-operate where appropriate. • I confirm this declaration is true and accurate in all aspects. • I understand by making a false statement could lead to prosecution. • Once the completed DOR form has been submitted, we will carry out a full investigation alongside the shipping company. This may include reviewing precise GPS delivery coordinates, photographic delivery records, and, where applicable, evidence from delivery personnel who may operate with body cameras. This information is used to verify deliveries and safeguard against fraudulent claims. You will be updated once the investigation is complete. Should you require assistance during this time, please contact us directly.

I AGREE AND CONFIRM

Date *

MM

DD

YYYY