Create Claim Request

Claim Information

Fields with * are required.

Claim is for *

Ward Pro Number *

Pickup Date *

Amount Claimed * ($xxx,xxx.xx)

Claim Type *

Is product available for salvage? *

Claimant Information

Company *

Claimant Reference No.

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Country

Phone *

Fax Number

Email *

Check sent to other address? *

Shipper Information

Shipper Name *

Address 1 *

Address 2

City *

State *

Zip *

Country

Phone

Consignee Information

Consignee Name *

Address 1 *

Address 2

City *

State *

Zip *

Country

Phone

Statement of Shortage or Damage

Detailed statement showing how amount claimed is determined (Number and Description of articles, nature and extent of loss or damage, invoice price of articles, amount of claim, etc.)

ALL DISCOUNTS AND ALLOWANCES MUST BE SHOWN

Detailed statement *

NMFC Item No. of commmodity damaged or lost

Weight of damaged or lost commodity

Total amount claimed * ($xxx,xxx.xx)

Documents to support claim (maximum 30 total files):

Original vendor's invoice or certified copy showing all discounts (Please include entire invoice)

Repair invoice showing breakdown of labor by hour and rate of pay if applicable along with all invoices for materials purchased to repair product if applicable

Original bill of lading or bond of indemnity thereof

Original paid freight bill or other carrier document bearing notation of damage or shortage if not shown on freight bill

Carrier's inspection report if copy has been provided

Other particulars obtainable in proof of damage / loss claimed

* Proof of Loss note: In the case of non-delivery or shortage, it will speed conclusion if claim includes a signed statement from the consignee certifying the goods claimed short have never been received from any other source and further notification will be given to the carrier to whom this was presented in the event said goods are ever received in the future.

* By submitting this claim claimant certifies the foregoing to be correct and agrees to indemnify the carrier against loss in the event the original bill of lading and/or original freight bill are not submitted. Claims must be filed within 9 months from date of delivery. Salvage must be retained until claim is concluded or is picked up by carrier. Carrier legally has 120 days to conclude a claim or advise claimant in writing after 120 days as to the status and reason for the delay in making final disposition.

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