FREIGHT LOSS/DAMAGE PRESENTATION Click Here to View Instructions
 SEKO Shipping No.
 		  Date Shipped
 		  Other Carrier Bill No.
 		  Claimant Ref No.
 
 Ship From:
 		  City / State
 
 Ship To:
 		  City / State
 
 
 Type of Claim
    Were the articles:
 Detailed Statement Showing how amount claimed is determined: Include number and description of articles, if only a portion of the shipment is lost or damaged, indicate how many pieces in total shipment (i.e. 1 lost out of 10). Clearly describe Nature and Extent of damage. Show Actual cost of goods. Show all discounts, allowances & salvage. Indicate amount claimed.
 Description (50 Character Max)  Claim $
   $ 
   $ 
   $ 
   $ 
   $ 
   $ 
 Is the damaged freight repairable?
 If No, Why? 		  Freight Charges Claimed:  $ 
 Salvage Value
 		  Packaged Weight(lbs)    Total Claim(s)   $   
 Were outer containers damaged?
  No. of outer containers damaged    Extent of damage to outer containers  
 Name of individual notified of Loss / Damage    Carrier Affiliation    City / Branch Office  
 Date and time of notification
 		  Method of notification
  Date freight Inspected  
Check the appropriate supporting documents. Please note: you will be able to attach the supporting documents to an email after you submit this form. please scan and e-mail or otherwise attach to the email on the next page to prevent processing delays:










Remarks (Explain the absence of any pertinent documentation - 250 Character Max)
 

The following Certification Must be completed by the Claimant
The Foregoing statement of facts is herby certified to as correct
 Company
 		  Person Filing
 
 Address / P.O. Box
 		  Telephone No.
 
 City / State / Zip
 		  Email
 		  Date
 




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Last Updated: Mar 18, 2012 @ 7:16:07 AM
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