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Sender or Shipper
Name/Contact *
Address
State/Province
ZIP/Postal Code
Mobile Phone *
Company
City
Country
Phone *
Email Address *
Recipient's or Consignee
Name/Contact *
Address
State/Province
ZIP/Postal Code
Mobile Phone *
Company
City
Country
Phone *
E-mail Address *
Shipment Information
Tracking or Freight Bill Numbers *
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
Declared value *
Declared value for customs
Merchandise value *
FedEx pack & ship fee
Freight charge
Total claim / C.O.D. amount
Customer remarks
Claimant Information
I accept that the foregoing statement of facts is hereby certified as correct. *
Date *
Claimant’s Name *
Phone *
State / Province *
ZIP / Postal Code *
Internal Reference No.
Claimant’s Address *
City *
Country *
E-Mail *
Submit