Claims Submission Form

General Information

Name(Required)

Shipment Details

MM slash DD slash YYYY
MM slash DD slash YYYY
Origin Address(Required)
Destination Address(Required)

Incident Details

MM slash DD slash YYYY

Damages/Loss

Products:(Required)
Product
Quantity
Unit Weight
Unit Cost
 
Additional Costs
(freight, repairs, labor, packaging, etc.)
Description
Amount (USD)
 
Required: BOL, Commercial Invoice, photos of damage, request for full value insurance (if applicable)
Drop files here or
Max. file size: 50 MB.