Standard Form for Presentation of Loss and Damage Claims

 [None] Select a Date Delete the Date  
 
 
 
 
 
 


This claim for the amount of $
    
is made against the carrier named above by:
 
for
 
in connection with the following described shipment:
 
 
 
 
 
 
 


DETAILED STATEMENT SHOWING HOW AMOUNT CLAIMED IS DETERMINED:

 


Total Amount 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 to carrier.
  2. Original PAID Probill/Waybill.
  3. Original or Copy of Purchase Invoice of Cargo being claimed to support the amounts being claimed.
  4. Other particulars obtained in proof of loss or damage claimed.
 

REMIT TO:
Midland Transport Ltd.
c/o claims Department
100 Midland Drive
Dieppe, NB E1A 6X4
Phone: (506) 858-5555
Fax: (506) 858-7701
Email: claims@midlandtransport.com



The foregoing statement of facts is hereby certified to be correct.

NOTE: CLAIM MUST BE FILED WITHIN 60 DAYS FROM THE DATE UPON WHICH YOU RECEIVED YOUR SHIPMENT.

 
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