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Standard Form for Presentation of Loss and Damage Claim

 Date (MM/DD/YY):   [None] Select a Date Delete the Date  * Company Name: *
 Phone Number: * Address: *
 Fax Number: * City/Province: *  *
 Contact Name: * Postal Code: *

 This claim in the amount of $  *   is filed against   *   for Loss or Damages in connection with the following described shipments:

 Description of Shipment: * 
 Name of consignor(shipper): * 
 Address of consignor(shipper): * 

 Shipped From: *  Shipped To: * 
 Paid Probill/Waybill Number: *  Date of Probill/Waybill: * 

 Name of consignee(whom shipped to): * 
 Address of consignee(whom shipped to): * 

DETAILED STATEMENT SHOWING HOW AMOUNT CLAIM IS BEING DETERMINED

*

 

Total amount claimed $ * 

IN ADDITION TO THE INFORMATION GIVEN ABOVE, THE FOLLOWING DOCUMENTS ARE TO BE FAXED TO (506) 858-7701 IN SUPPORT OF THIS CLAIM

  1. Original Bill of Lading, if not previously surrendered to carrier. 
  2. Original PAID Freight (expense) Bill. 
  3.  Original Invoice or Photostat Copy. 
  4.  Other particulars obtained in proof of loss or damage claimed.

 
Remarks:

 

The forgoing statement of facts is hereby certified to be correct.

   

NOTE: CLAIM MUST BE FILED WITHIN 60 DAYS FROM THE DATE IN WHICH YOU RECEIVED YOUR SHIPMENT