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Download statement of claim - Specialized Transportation, Inc.
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Cargo Claim STATEMENT OF CLAIM Use the tab key to input information Contract # _______________ File #_______________ Your Reference #_______________ __________ Date __________________________________ Signature of Claimant _____________________________________ Printed Signature ________________________________ Company Name if Applicable ____________ Telephone Including Area Code __________________________________ Mailing Address _______________________________________ City, State, Zip This claim for $____________ is made against STI by ______________________________ in connection with the above referenced shipment. Cargo Claim Information ARTICLE DESCRIPTION OF DAMAGE WEIGHT INVOICE COST TOTAL AMOUNT CLAIMED AMOUNT CLAIMED ____________ In addition to the information stated above, the following documents are submitted in support of my claim. Please explain under remarks an absence of any of the documents called for in connection with your claim. 1. Copy of the bill of lading and inventory. 2. Copy of paid freight bill. 3. Original or certified copy of purchase invoice. 4. Document to support weight(s) of damage/missing article(s) 5. Documents to support repair cost. Remarks ______________________________ FAILURE TO SUBMIT THE PROPER DOCUMENTS TO SUPPORT YOUR CLAIM MAY RESULT IN A DELAY/DENIAL OF YOUR CLAIM. AS A CONDITION PRECEDENT TO RECOVERY A CLAIM MUST BE FILED IN WRITING WITHIN NINE MONTHS AFTER DELIVERY. Return Claim form: By Mail: By Fax: By Email: STI Attn: Cargo Claims PO Box 80520 Fort Wayne, IN 46898 260.429.2920 [email protected] Specialized Transportation, Inc.
