Claim Form - Fedex Claims Dept.
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1Claim Form
For lost and damaged shipments
Sender
Sender’s Name/Contact
Internal reference no.
Information
Company
Claim settlements are
Address
issued to sender unless a
City
State/Province
letter of authorisation
from shipper is submitted
Country
ZIP/Postal code
Phone.
Fax
E-mail
__________
Recipient’s Name/Contact
__________________________________ _________
Recipient information
.
Company
Address
City
State/Province
Country
ZIP/Postal code
Tel.
Fax.
E-mail
__________
Tracking-number
FedEx ExpressTracking-number
(Only one claim per form allowed)
Shipdate
No of packages
Weight____
Shipment Information
FedEx Express-control number
_________
Contents of shipment
Describe damage to outer packaging
£ Loss
£ Complete
Describe damage to inner contents
£ Partial
Describe inner packaging
£ Damage
Please retain all packaging
___
and products until your
claim is resolved
Declared value for customs
declared value for carriage
__
(Indicate currency
indicate currency
) ______
(
)
(The value declared on the shipment when tendered to FedEx)
£ Complete
£ Partial
Merchandise value
) _________ Freight charge ____________ Total claim amount_________
(Indicate currency
£ Concealed
(
repair)
Original purchase price and/or cost to
£ Other
Customer remarks
_________
The foregoing statement of facts is hereby certified as correct.
Signature
Date___
_________
Claimant’s name
Phone.______
(please print)
Required
Claimant’s Address
__________
Signature
Mail or Fax
Please return the completed form and requested documentation to :
FedEx Claims Dept.: Sutherland House, Matlock Road, Coventry, CV1 4JQ – fax 02476 669756 or email to
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