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.)
(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).