Claim Form — Claims Right

Your External Claims Department

Cargo Claim Form

Claimant Contact Information

Company Name

Contact Name

First Name

Last Name

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?

Claimant Claim Number

Claim Amount

Type of Claim

Description of Claim

Who did you notify of potential claim?

Date Notified

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

YYYY

Date Received

YYYY

Shipment Type

If other, please advise type.

Insured or Declared Value?

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

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

YYYY