claims 2012

Sender or Shipper’s Name / Contact Recipient’s or Consignee’s Name / Contact Company Company Address Address City State / Province City State / Province Country ZIP / Postal Code Country ZIP / Postal Code Phone Fax Phone Fax E-Mail E-Mail I accept that the foregoing statement of facts is hereby certified as correct. Date Signature (for fax or mail) Internal Reference No. Claimant’s Name (please print) Claimant’s Address Phone City State / Province Country ZIP / Postal Code E-Mail Fax Claim Form For lost or damaged U.S. or international shipments Tracking or Freight Bill Numbers Salvage Claimant Information E-mail, Fax or Mail Shipment Information Additional tracking numbers for this claim request allowed (must have same sender, recipient, and ship date) Loss Complete Partial Damaged Please retain all packaging and merchandise until your claim is resolved. C.O.D. For FedEx Express ® and FedEx Ground ® Only Ship date No. of packages Weight FedEx control number (NOTE: Call 1.800.GoFedEx 1.800.463.3339 to obtain a FedEx Express control number or a FedEx Ground damaged call tag confirmation number.) Qty of Packages Item # Item Description Claimed Amount Contents of shipment Describe damage to outer packaging Describe inner packaging Describe damage to contents Declared value (The value declared on the shipment when tendered to FedEx) $ Declared value for customs (International shipments only) $ Merchandise value (Original purchase value and/or cost to repair) $ FedEx pack & ship fee $ Freight charge $ Total claim / C.O.D. amount $ Customer remarks If your claim is filed for damage, and mitigation through repair or allowance is not possible, please explain why and provide contact information for salvage pickup. Salvage should be held until investigation of the claim is complete. Salvage Contact Phone Fax Please return the completed form and required Proof of Value documentation (invoice and/or receipt) to: E-mail: fi[email protected] | Fax 1.877.229.4766 | FedEx Cargo Claims Dept. P.O. Box 256 Pittsburgh, PA 15230 31581PL 1/09 SUBMIT

Upload: amberskies

Post on 25-Nov-2015

5 views

Category:

Documents

0 download

Report

Download

Embed Size (px):

DESCRIPTION

claims for injury

TRANSCRIPT

Sender or Shippers Name / Contact Recipients or Consignees Name / ContactCompany CompanyAddress Address City State / Province City State / Province Country ZIP / Postal Code Country ZIP / Postal CodePhone Fax Phone FaxE-Mail E-Mail

I accept that the foregoing statement of facts is hereby certified as correct. DateSignature (for fax or mail) Internal Reference No.Claimants Name (please print)Claimants Address PhoneCity State / ProvinceCountry ZIP / Postal CodeE-Mail Fax

Claim FormFor lost or damaged U.S. or international shipments

Tracking or Freight Bill Numbers

Salvage

Claimant Information

E-mail, Fax or Mail

Shipment Information

Additional tracking numbers for this claim request allowed (must have same sender, recipient, and ship date)

Loss Complete Partial

DamagedPlease retain all packaging and merchandiseuntil your claim is resolved.

C.O.D.For FedEx Express and FedEx Ground Only

Ship date No. of packages Weight

FedEx control number(NOTE: Call 1.800.GoFedEx 1.800.463.3339 to obtain a FedEx Express control number or a FedEx Ground damaged call tag confirmation number.)

Qty of Packages Item # Item Description Claimed Amount

Contents of shipment

Describe damage to outer packaging

Describe inner packaging

Describe damage to contents

Declared value(The value declared on theshipment when tendered to FedEx) $

Declared value for customs(International shipments only) $

Merchandise value(Original purchase value and/or cost to repair) $

FedEx pack & ship fee $ Freight charge $ Total claim / C.O.D. amount $

Customer remarks

If your claim is filed for damage, and mitigation through repair or allowance is not possible, please explain why and provide contact information for salvage pickup. Salvage should be held until investigation of the claim is complete.

Salvage Contact Phone Fax

Please return the completed form and required Proof of Value documentation (invoice and/or receipt) to:E-mail: [email protected] | Fax 1.877.229.4766 | FedEx Cargo Claims Dept. P.O. Box 256 Pittsburgh, PA 15230

31581PL 1/09SUBMIT

Sender_Contact: Recipient_Contact: Sender_Company: Sender_Address: Sender_City: Sender_State: Recipient_City: Sender_Country: Sender_Zip: Recipient_Country: Sender_Phone: Sender_Fax: Sender_Email: Recipient_Company: Recipient_Address: Recipient_State: Recipient_Zip: Recipient_Phone: Recipient_Fax: Recipient_Email: Tracking_Numbers_1: Tracking_Numbers_2: Shipment_Ship_Date: Shipment_Num_Pkgs: Shipment_Wt: Radio Button1:

Shipment_Control_Num: Qty_Pkg_1: Item_1: Item_Desc_1: Claim_Amt_1: Qty_Pkg_2: Item_2: Item_Desc_2: Claim_Amt_2: Qty_Pkg_3: Item_3: Item_Desc_3: Claim_Amt_3: Contents_Shipment: Describe_Dam_Outer: Describe_Dam_Inner: Describe_Dam_Contents: Declared_Value: Declared_Value_Customs: Merchandise_Value: Pack_Ship_Fee: Freight_Charge: COD_Amt: Customer_remarks_1: Customer_remarks_2: Salvage_Contact: Salvage_Phone: Salvage_Fax: Acceptance: Check Box1: Claimant_Signature: Claimant_Name: Claimant_Address: Claimant_City: Claimant_Country: Claimant_Email: Claimant_Date: Claimant_Internal_Ref_Num1: Claimant_Internal_Ref_Num2: Claimant_Phone: Claimant_State: Claimant_ZIP: Claimant_Fax: Submit: