Cargo Claim Form Claimant Contact Information Company Name Contact Name * First Name Last Name Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * Country (###) ### #### Fax (###) ### #### Claim Details Company Claim is Against Is this a formal claim or notice of potential claim? Formal Claim Notice of Potential Claim Claimant Claim Number Claim Amount $ Type of Claim Concealed Damage Loss Missing Pieces Property Visible Damage Other Description of Claim Who did you notify of potential claim? Date Notified MM DD YYYY Total pieces loss/damage Total weight loss/damage (please specify kg or lb) Other info you feel is necessary Shipment Details Housebill or Shipment Number (HAWB) Date Shipped MM DD YYYY Date Received MM DD YYYY Shipment Type Domestic International Ground Air Ocean Rail Property Other If other, please advise type. Insured or Declared Value? Insured Declared Value Neither Insured or DV amount? (if applicable) $ Insurance Certificate Number (if applicable) Total Pieces of Shipment Total Weight of Shipment (please specify kg or lb) Shipper Consignee Commodity Freight Charges Paid Unpaid Other If other, please explain: Please be sure to hold onto any damaged freight for possible inspection. All supporting documentation should be sent to office@claimsrightllc.com. For a list of supporting documents, please contact us. Claimant Signature * The foregoing statement of facts is hereby certified to as correct: Date MM DD YYYY Your form has been submitted. Please contact us if we have not reached out within 48 hours of submission. Thank you!