Shipment Information
Loss
Damaged
C.O.D.
Loss (If Loss was selected under Shipment Information)
Complete
Partial
N/A
Ship date
No. of packages
Weight
FedEx control number
Quantity of Packages *
Item Number *
Item Description *
Claimed Amount *
Quantity of Packages
Item Number
Item Description
Claimed Amount
Quantity of Packages
Item Number
Item Description
Claimed Amount
Contents of shipment
Describe damage to outer packaging (If Damaged was selected under Shipment Information)
Describe damage to inner packaging (If Damaged was selected under Shipment Information)
Describe damage to contents (If Damaged was selected under Shipment Information)
Declared value *
FedEx pack & ship fee
Declared value for customs
Freight charge
Merchandise value *
Total claim / C.O.D. amount
Customer remarks