Claims Form

Waybill# *

Date of Claim *

Date of Shipment *

Claimant's Claim Number *

Loss Type *

Declared Value *

Claimant Information

Company *

Account # *

Contact name *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Fax

Email

Claim Details

Damages noted at time of delivery:

Yes
No

Description of Shipment *

Shipper's Name *

Shipper's Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Consignee's Name *

Consignee's Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Claim item

# of Pieces *

Weight *

Shipment Description *

Amount Claimed *

Additional Details

Inner and outer description

Are goods available for inspection:

Yes
No

Current location

Company name

Are goods salvageable or repairable:

Yes
No

Additional Details

Upload a PDF copy of the Wholesale invoice for the claims

Drag & Drop Files, Choose Files to Upload

Upload and additional documents in a single PDF format.

Drag & Drop Files, Choose Files to Upload

This will only accept one PDF file. You will have to compile all the files into one PDF document