Claims Form

Claims Form

MM slash DD slash YYYY
is made against your company for

In connection with the following described shipment:

DETAILED STATEMENT SHOWING HOW AMOUNT CLAIMED IS DETERMINED

Number & description of articles, nature & extent of loss or damage, invoice prices of articles, amount of claim etc.)
In addition to the above, the following documents are submitted in support of this claim:
(Note: The absence of any document called for in connection with this claim must be explained. When impossible for claimants to produce original documents of lading or unpaid freight bill, a bond of indemnity must be given to the carrier against duplicate claim supported by original documents).
INDEMNITY AGREEMENT
MM slash DD slash YYYY

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