jueves, 20 de agosto de 2009

Claimant for Reduced Price

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Claimant for Reduced Price

Date: ____________________________________

Claimant's Name: _____________________________

Address of Claimant: __________________________

___________________________

Name of Carrier: _____________________________

Address of Carrier: __________________________

__________________________

This claim for $ ______ (_____________________________ & ____/100 dollars) is made against the carrier named above by _________________________, Claimant, for overcharge in connection with the following shipment(s):

Description of Shipment: ____________________________

Name and address of Shipper: _________________________

Shipped from ____________________________ to ____________________

Final Destination: ______________________ Routed Via ____________

Bill of lading issued by _______________________ (Company) on the ______________ day of _________________, 19___.

Paid freight bill No. _________________ Truck No. _____________

And initials ___________________________,

Name and Address of recipient __________________.

Nature of Overcharge: __________________________

DETAILED STATEMENT SHOWING HOW AMOUNT CLAIMED IS DETERMINED

Number of packages __________________, articles _______________, weight ___________, rate ___________, charges _____________, amount of overcharge ________________ Dollars.

Authority for rate or classification claimed: __________________________________________

In addition to the information given above, the following documents are submitted in support of this claim:

(___________) 1. Original Bill of lading, if not previously surrendered by carrier.

(___________) 2. Original Paid freight ("expense") bill.

(___________) 3. Original Invoice or Certified Copy.

(___________) 4. Weight Certificate or certified statement when claim is based on misrouting or valuation.

(___________) 5. Other Particulars obtainable in proof of loss or damage claimed: __________.

Remarks: ________________________________________________________

________________________________________________________________

________________________________________________________________.

The above statement of facts is hereby certified as correct.

Dated: ________________________________.

______________________________________

CLAIMANT


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