home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
Complete Home & Office Legal Guide
/
Complete Home and Office Legal Guide (Chestnut) (1993).ISO
/
ex
/
fib
/
sale
/
oc_clm.ws
(
.txt
)
< prev
Wrap
WordStar Document
|
1993-08-01
|
3KB
|
86 lines
Date:____________________________________
Claimant's Name: _____________________________
Address of Claimant:__________________________
___________________________
Name of Carrier: _____________________________
Address of Carrier: __________________________
__________________________
This claim for $ ___________________ (__________________________
_____________ & ____/100 dollars) is made against the carrier
named above by _________________________, Claimant, for overcharge
in connection with the following shipment(s):
Description of Shipment:____________________________
Name and address of Shipper:_________________________
Shipped from ____________________________ to ____________________
Final Destination: ______________________ Routed Via ____________
Bill of lading issued by ___________________________ (Company) on
the __________________ day of _________________, 19___,
Paid freight bill No. _________________ Truck No. _____________
and initials ___________________________,
Name and Address of recipient __________________.
Nature of Overcharge:__________________________
DETAILED STATEMENT SHOWING HOW AMOUNT CLAIMED IS DETERMINED
Number of packages ___________________, articles
_______________, weight ___________, rate ___________, charges
______________, amount of overcharge ________________ Dollars.
Authority for rate or classification
claimed:_____________________________________________________
In addition to the information given above, the following
documents are submitted in support of this claim:
(___________) 1. Original Bill of lading, if not previously
surrendered by carrier.
(___________) 2. Original Paid freight ("expense") bill.
(___________) 3. Original Invoice or Certified Copy
(___________) 4. Weight Certificate or certified statement when
claim is based on misrouting or valuation.
(___________) 5. Other Particulars obtainable in proof of loss or
damage claimed: ____________________________________________.
Remarks:________________________________________________________
________________________________________________________________
________________________________________________________________.
The above statement of facts is hereby certified as correct.
Dated:________________________________.
______________________________________
CLAIMANT