Shipment is damaged

Sender or Shipper

Name/Contact *

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Address

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State/Province

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ZIP/Postal Code

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Mobile Phone *

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Company

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City

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Country

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Phone *

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Email Address *

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Recipient's or Consignee

Name/Contact *

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Address

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State/Province

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ZIP/Postal Code

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Mobile Phone *

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Company

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City

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Country

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Phone *

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E-mail Address *

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Shipment Information

Tracking or Freight Bill Numbers *

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Ship date

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No. of packages

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Weight

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FedEx control number

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Quantity of Packages *

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Item Number *

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Item Description *

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Claimed Amount *

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Quantity of Packages

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Item Number

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Item Description

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Claimed Amount

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Quantity of Packages

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Item Number

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Item Description

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Claimed Amount

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Contents of shipment

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Describe damage to outer packaging (If Damaged was selected under Shipment Information)

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Describe damage to inner packaging (If Damaged was selected under Shipment Information)

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Describe damage to contents (If Damaged was selected under Shipment Information)

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Declared value *

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Declared value for customs

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Merchandise value *

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FedEx pack & ship fee

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Freight charge

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Total claim / C.O.D. amount

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Customer remarks

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Salvage

If your claim is filed for damage, and mitigation through repair or allowance is not possible, please explain why and provide contact information for salvage pickup. Salvage should be held until investigation of the claim is complete.

Salvage Contact

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Phone

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fax

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Claimant Information

I accept that the foregoing statement of facts is hereby certified as correct. *

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Date *

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Claimant’s Name *

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Phone *

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State / Province *

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ZIP / Postal Code *

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Internal Reference No.

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Claimant’s Address *

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City *

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Country *

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E-Mail *

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