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Claim for Damage
TO (CARRIER):

FROM (CLAIMANT):

SHIPMENT FROM:

SHIPMENT TO:

SHIPMENT BY:

SHIPMENT TO:

BILL OF LADING #:

DELIVERY DATE:

As ........... Shipper/ .......... Recipient, we hereby give Notice to you, the Carrier, that the
following goods received through described above were found to be damaged:
RE
F#

Q
T
Y

DESCRIPTION
OF ITEM

DESCRIPTION OF
DAMAGE



TOTAL CLAIMED

VALUE

$

Compensation for the above damages is hereby claimed and demanded. Such claim does
not limit our rights to further claims and damages, in the event additional claims or
damages are discovered on account of such delivery.
Settlement with or release to you does not waive any of our rights against any third party,
nor does the same with any third party waive any rights against you. All rights are


reserved, cumulatively and not exclusively. Nothing contained herein shall alter any other
documentation issued by us, unless specifically so stated.
Claimant:
by:
Authorized Signatory



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