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GOODS IN TRANSIT CLAIM FORM
STATEMENT AND PARTICULARS OF CLAIMS
The Issues of this Claim Form is in no way an admission of liability. It should be completed as fully and accurately as possible and returned immediately.
PARTICULARS OF LOSS OR DAMAGE
Place where damage occurred:
Describe fully how loss or damage occurred and circumstances under which discovered:
Destination of Goods:
Name of Carrier:
Address of Carrier:
Nature of Contract:
If Printed contract, please attach a copy:
If by rail, at whose risks were goods conveyed?
If by road, state registered letters and numbers of vehicle:
Name of insurers of the vehicle:
Value of Consignment:
How were the goods packed and by whom?
What condition were they received by carrier for transit?
Was the loading supervised by a senior official in your company?
Condition of package when received?
(if claim is for partial lost)
Nature of receipt given by the carrier of the consignor. If clause, the exchange word of the clause should be stated:
Nature of receipt given by the consignee of the carrier:
Particulars of vehicle registered number:
Carrying capacity description, year of make:
Is the claimant the owner of the goods?
If not, state in what capacity the claim is being made:
The name address of owner:
If claim for recovery made against carrier or third parties give particulars and result:
Please attach correspondences here:
Is there any insurance covering the loss?
The following document(s), where applicable are required in support of this claim and should be attached to this form
(A) Invoice or account
(B) A true copy of the receipt given for the goods
(C) The signed delivery note obtained when the goods were delivered
(D) Any other relevant document or correspondence received
I/We declare that the foregoing answers are true and complete.
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