Collect on Delivery (C.O.D.)

Sender or Shipper

Name/Contact *

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Address

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State/Province

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ZIP/Postal Code

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Mobile Phone *

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Company

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City

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Country

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Phone *

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Email Address *

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Recipient's or Consignee

Name/Contact *

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Address

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State/Province

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ZIP/Postal Code

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Mobile Phone *

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Company

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City

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Country

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Phone *

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E-mail Address *

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Shipment Information

Tracking or Freight Bill Numbers *

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Ship date

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No. of packages

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Weight

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FedEx control number

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Quantity of Packages *

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Item Number *

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Item Description *

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Claimed Amount *

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Quantity of Packages

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Item Number

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Item Description

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Claimed Amount

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Quantity of Packages

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Item Number

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Item Description

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Claimed Amount

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Contents of shipment

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Declared value *

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Declared value for customs

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Merchandise value *

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FedEx pack & ship fee

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Freight charge

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Total claim / C.O.D. amount

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Customer remarks

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Claimant Information

I accept that the foregoing statement of facts is hereby certified as correct. *

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Date *

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Claimant’s Name *

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Phone *

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State / Province *

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ZIP / Postal Code *

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Internal Reference No.

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Claimant’s Address *

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City *

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Country *

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E-Mail *

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