Test Claim Form – AMERICAN LINEHAUL

AIRBILL OR AIRWAY BILL #
AIRFREIGHT CLAIM NUMBER
DATE OF SHIPMENT
CLAIMANT'S NUMBER
CLAIM BREAKDOWN
QUANTITY | UNIT | DESCRIPTION | DETAILED REASON FOR CLAIM | AMOUNT OF CLAIM
TOTAL AMOUNT OF CLAIM
NOTIFICATION OF LOSS OR DAMAGE WAS GIVEN TO
By:
FAXLETTEROTHER
ON Click to select a date
AT Click to select a timeHHMMAM/PM
INSPECTION WAS MADE BY:
DATE
ATTACH ORIGINAL OR CERTIFIED COPY OF THE FOLLOWING SUPPORTING DOCUMENTS (PLEASE NOTE THAT IF YOU HAVE MULTIPLE DOCUMENTS TO SEND FOR ANY OF THE FOLLOWING 7 ITEMS, YOU CAN ONLY UPLOAD ONE FILE FOR EACH OF THE 7 CATEGORIES. IF YOU HAVE MULTIPLE DOCS FOR ANY ONE OF THEM, YOU MUST SCAN THEM AS A SINGLE DOCUMENT.
1. COPY OF HOUSEBILL
NAME OF CLAIMANT
2. COPY OF DELIVERY RECEIPT OR RECEIPT OF REFUSAL
MAILING ADDRESS
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
3. COPY OF ORIGINAL RECEIPT OF PURCHASE
4. COPY OF RECEIPT OR REPLACEMENT
5. COPY OF YOUR CLIENTS CLAIM AGAINST YOU
PHONE
6. PHOTO OF INNER & OUTER PACKAGING & DAMAGE ITEMS (FOR DAMAGE CLAIMS)
EMAIL ADDRESS
7. PROOF OF PAYMENT BY YOU TO YOUR CLAIMANT
THE FOREGOING STATEMENT OF FACTS IS HEREBY CERTIFIED AS TO CORRECT CLAIMANT OR CLAIMANT'S REPRESENTATIVE
DATE