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Transport and warehousing · Form

Sample Form: گزارش آسیب مرسوله

گیرنده آسیب را با عکس و بارنامه گزارش می‌دهد؛ برای بیمه و پیگیری.

7 questions · Free up to 50 responses a month

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About this template

“گزارش آسیب مرسوله” has 7 questions; every question is required. Question types: Short text (2), Mobile number (1), Date (1), Single choice (1), Long text (1), File upload (1). 3 ready-made options across 1 choice questions, all editable in the online version.

In the online version of this template

  • Mobile numbers are validated against the Iranian number format.
  • Dates are picked and stored on the Jalali (Persian) calendar.
  • Attached files are stored with the response.
Related:Online form builder

Questions in this template

  1. 1.

    نام و نام خانوادگی *

    (Short text)
  2. 2.

    شماره موبایل *

    (Mobile number)
  3. 3.

    شماره بارنامه *

    (Short text)
  4. 4.

    تاریخ دریافت *

    (Date)
  5. 5.

    شدت آسیب *

    (Single choice)
    • جزئی
    • قابل استفاده با تعمیر
    • غیرقابل استفاده
  6. 6.

    شرح *

    (Long text)
  7. 7.

    عکس‌ها *

    (File upload)

Printable or online?

Printable version (Word & PDF)

  • For filling in on paper, signing and filing by hand
  • Edit the Word file any way you like
  • Collecting and typing up the answers is up to you
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Online version on Porsino

  • Answers are collected and organised automatically — no retyping
  • National ID, mobile number and dates are validated instantly
  • Ready-made reports and charts, plus Excel export in one click
  • Share a link or QR code — it works on mobile too
Build the online version for free

How do I use this template?

  1. Sign up for Porsino for free; no bank card needed.
  2. In the panel, open “Templates” and choose “گزارش آسیب مرسوله”.
  3. Change the questions as you like, publish the form and send the link.

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