FORM FOR PRESENTATION OF

LOSS OR DAMAGE CLAIM

   
1
TO: SCOTT-WOODS TRANSPORT INC.
140 MALOY STREET
MAPLE, ONTARIO L6A 1R9
   
This claim for $  is made against your company for  DAMAGE LOSS in connection with the following
described shipment:

DATE

CLAIMANTS NUMBER

SHIPPER'S NAME

POINT SHIPPED FROM

DATE OF BILL OF LADING

CONSIGNEE'S NAME

DATE OF DELIVERY
   
 
2
DETAILED STATEMENT SHOWING HOW AMOUNT CLAIMED HAS BEEN DETERMINED
(Number and description of articles, nature and extent of damage, invoice price of articles, amount of claim etc.                                                                                   

                                                      ALL DISCOUNTS AND ALLOWANCES MUST BE SHOWN)

 

 

 

 

 

 

 

 

 

NMFC Item # of

Commodity lost or damaged                                                     TOTAL AMOUNT CLAIMED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

THE FOLLOWING DOCUMENTS ARE SUBMITTED IN SUPPORT OF THIS CLAIM:

 

    Original Bill of Lading

    Original invoice or certified copy

    Shipper’s concealed loss or damage form

    Consignee concealed loss or damage
form

    Other particulars obtainable in proof of
loss or damage claimed

   
 
3
  FURTHER DETAILS OR REMARKS:



NAME OF PERSON SUBMITTING CLAIM
COMPANY
TELEPHONE
EMAIL
DATE
SIGNATURE