Cargo Claim Form
美国城市排名The Insurers do not admit liability by the issue of this form.
Claimant ___________________________________________________ Phone _______________________________
Address ____________________________________________________ Fax _________________________________
___________________________________________________________
Cargo Details
Policy/Certificate number ________________________________________________________________________________
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Description of cargo _____________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Number & type of packages _______________________________________________________________________________
Cargo containerid? yes∼no If yes, FCL LCL ISO hard top ISO open top ISO flat rack
ISO insulated box Other
Container number ________________________________
Voyage Details
新年贺岁片From __________________________ Transhipped ___________________________ To ____________________
Vesl name(s) __________________________________ Voyage/Flight no(s) ___________________________________
Import Export Within China
Terms of sale Ex works CFR FOB CIF FIS Other
Date goods · Unloaded from overas vesl/craft / / · Received at final store / /
Shipping Company / Airline name _________________________________________________________________________
Road Carrier’s name _________________________________________________________________________
Customs Agent’s name __________________________________________________________________________
Address __________________________________________________________________________
oscoLoss Details
Plea describe the nature of the damage and how it occurred
______________________________________________________________________________________________________
freak of nature
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Date damage discovered / / Customs inspection date / / at ____________________________
Loss estimate $ ______________________
Cau of loss/damage attributed to: _________________________________________________________________________英文网名女孩
______________________________________________________________________________________________________
Action taken to reduce damage/safeguard cargo ____________________________________________________新的开始 英文___________
______________________________________________________________________________________________________
Was the damage/loss noted at the time of delivery?china pub yes ∼no (Plea circle)
If no, why not? _________________________________________________________________________________________
If yes, was this noted on delivery documentation? yes∼no
Describe the external condition of the packages when delivered __________________________________________________
______________________________________________________________________________________________________
Has the shipping company/carrier surveyed the damage? yes∼no
Has a claim been lodged against the shipping company/carrier? yes∼no
Documentation
· Original documents are required.
· Plea tick the name of each document attached to this form.
❑Commercial invoice
usata
❑Packing list
❑Original marine insurance policy/certificate of insurance
❑Original bill of lading/airway bill (or legible copy with rever side)
❑Claud delivery receipt;
❑Letter against common carrier and their reply (if any)
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❑Photos
❑Claim notes/Statement of Claim
❑Other relevant documents
Anti-fraud Notice (Required by JS CIRC)
Good faith reprents a fundamental principle underlying an insurance contract and any person suspected of insurance fraud will be subject to the following liabilities
Criminal Liability: Criminal activities of insurance fraud may be subject to punishment of criminal detention, imprisonment, fines or penalties, or confiscation of property. The apprair and/or certifier of an insured event who intentionally provides fal supporting documents for any other person to commit an insurance fraud will be punished as an accomplice for crime of insurance fraud.
