Loss and Damage Claims - RD Logistics Inc

Company name of Claimant(Required)

Address of claimant(Required)

Name of Carrier(Required)

Date(Required)

Claimant's Number

PRO Number(Required)

Claim Reference Number

Name of Claimant(Required)

Loss or Damage(Required)

Description of shipment(Required)

Name and address of consignor (shipper)(Required)

Shipped From(Required)

To(Required)

Date of Bill of Lading(Required)

Name and address of Consignee (Whom shipped to)(Required)

If shipment reconsigned enroute, state particulars

DETAILED STATEMENT SHOWING HOW AMOUNT CLAIMED IS DETERMINED(Required)

Nature and Extent of loss or damage

Amount

Supporting document(Required)

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, docx, tiff, Max. file size: 20 MB, Max. files: 5.

Supporting document of the potential loss or damage.

Total Amount Claimed(Required)

Remarks

Claimants contact phone number(Required)

Printed name of claimant(Required)

Signature of claimant(Required)