Loss/Damage Claim Form

Airbill or Airway bill #

Airfreight Claim Number

Date of Shipment

Claimant's Number

Quantity	Unit	Description	Detailed reason for claim	Amount of claim









			Total Amount of Claim

Notification of loss or damage was given to

By Fax Letter Other

Inspection was made by:

Name/Title

Date

Attach original or certified copy of the following supporting documents (please note that if you have multiple documents to send for any of the following 7 items, you can only upload ONE file for each of the 7 categories. If you have multiple docs for any one of them, you must scan them as a single document.

upload file

1. Copy of Housebill

upload file

2. Copy of Delivery Receipt or receipt of refusal

upload file

3. Copy of original Receipt of purchase

upload file

4. Copy of Receipt or replacement

upload file

5. Copy of your clients claim against you

upload file

6. Photo of inner & outer Packaging & Damaged items
(for damage claims)

upload file

7. Proof of payment by you to your claimant

Name of Claimant

Mailing Address

City, ST, ZIP

Phone/Fax

Email Address

The foregoing statement of facts is hereby certified to as correct:

Claimant or Claimant's representative

date