Shipper's Name
Point Shipped From
Name of Carrier Issuing Bill of Lading
Date of Bill of Lading
Routing of Shipment
|
Consignee's Name
Final Destination
Name of Delivering Carrier
Date of Delivery
Delivering Carrier's Freight Bill Number
|
| If shipment
reconsignment enroute, state particulars:
|
|
DETAILED STATEMENT SHOWING AMOUNT
CLAIMED IS DETERMINED
(Number and description of articles, nature and extent
of loss or damage,
invoice price of articles, amount of claim, etc.)
ALL DISCOUNT and ALL ALLOWANCES MUST BE SHOWN
NMFC Item No. of commodity lost or damaged
Total Amount Claimed |
The following
documents will be submitted in support of this claim via fax to 828-728-8942
Original
Bill of Lading
Original
invoice or certified copy
Original paid freight bill or other carrier document bearing
notation
of loss or damage if not shown of freight bill
Carrier's Inspection Report Form (Concealed loss or damage).
Shippers concealed loss or damage form.
Consignee concealed loss or damage form.
Other particulars obtainable in proof of loss or damaged
claimed.
(NOTE: The absence of any document
called for in conjunction with this claim must be explained.
When impossible for claimants to produce the Original Bill
of Lading, or paid freight bill, a bond of indemnity must be
given to protect carrier against duplicate claims supported
by original documents.) |
|
INDEMNITY AGREEMENT |
| In the absence of
the Original Freight Bill and/or Original Bill of Lading, we
agree to hold the above named carrier to whom this claim is
presented and any other participating carrier, harmless and
indemnified against any and all lawful claims which may be
made against it or those arising out of the same shipment
and will pay to said carrier and any participating carrier(s),
all losses, damages, costs, counsel fees or any other
expenses which they or any of them may suffer or pay by
reason of payment of our claim, herein described, without
the surrender of the Original Freight Bill or Bill of
Lading, as such was not provided and/or cannot be located |
The foregoing
statements of facts is hereby certified as correct.
Date
Company's Name
Contact-Title
Mailing Address |
|
INSPECTION REPORT |
Newton's Pro #
Manufacturer
Ack #
Item #
Description
Description of damage (please be specific)
Is there any carton damageYes
No
If Yes, please describe
Is original carton on handYes
No(carton
and packaging must be held until claim is resolved.)
Is this an imported itemYes
No
Describe packaging and inner pack
Can the item be repairedLocallyby
Manufacturer
Invoice cost of item
Cost of local repairs
Can item be sold at a discountYes
No
Discount amount requested
Where was merchandise when damage was discovered
Current location of merchandise
Description of receiving facilityreceiving
dockground
level receving Other (please describe)
Additional comments
Note: Report is merely a statement of facts and does not
acknowledge carriers liability. |
