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Standard Form for Presentation of Loss and Damage Claims
  • USD CND
  • Noted damage Concealed damage Shortage Theft
  • Yes No
  • Yes No
  • Cosmetic Functionality
  • Yes No
  • Yes No

Shipper

Consignee

DETAILED STATEMENT SHOWING HOW CLAIM AMOUNT IS DETERMINED.
(Number and description of articles, nature and extent of loss or damage, invoice price of articles, amount of claim, etc)
SHOW ALL DISCOUNTS AND ALLOWANCES
Detail of Damage and/or Item Numbers*
Amount * (for ex: 99.99)
   
   
   
   
   

Upload Documents (10 MB max for all the documents combined.)

WHEN FOR ANY REASON, THE ORIGINAL PAID FREIGHT BILL OR BILL OF LADING IS NOT PROVIDED, CLAIMANT MUST INDEMNIFY CARRIER OR CARRIERS AGAINST DUPLICATE CLAIMS SUPPORTED BY ORIGINAL DOCUMENTS

INDEMNITY AGREEMENT

When the original bill of lading and/or freight bill is not submitted, or is not available for submission, but copies of the original are submitted in support of the claim described above, the claimant agrees to indemnify and hold harmless the carrier receiving this claim, named above, and any participating carriers, and will pay to the carrier or any participating carrier all losses, costs, damages, counsel fees or any other expenses it (the carrier) may incur resulting from all lawful subsequent duplicate claims arising out of the same shipment which may be filed and supported by the original documents.

Foregoing statement of fact is hereby certified as correct.