Bill Of Lading Form

P.O. BOX 2020

DRUMHELLER, AB T0J 0Y0

REF. #

DATE

127 5001

1

DS #

PHONE 1 (800) 622-5800

GST # R 102366648

TO CONSIGNEE

FROM SHIPPER

2

3

ADDRESS

ADDRESS

CITY

PROVINCE

POSTAL CODE

CITY

PROVINCE

POSTAL CODE

(

) -

(

) -

TELEPHONE

TELEPHONE

INTERLINE

SPECIAL NOTATIONS

SPECIAL NOTATIONS

D.G.

QUALITY FLOW SYSTEM

NUMBER AND TYPE OF PKGS.

PARTICULARS OF GOODS, MARKS AND EXCEPTIONS

WEIGHT

X

KG

LB

CHKR

UNIT

PIECE

FREIGHT CHARGES

□ □

INIT

#

COUNT

9

COLLECT

PREPAID

UNLOAD

BY

Freight charges will be collect

unless marked prepaid.

RELOAD

4

5

6

Quotation #

BY

Q

UNLOAD

BY

C.O.D. SHIPMENTS

RELOAD

BY

10

AMOUNT $

EXCEPTIONS

CHKR

INIT

C.O.D. FEE

C.O.D. FEE

COLLECT

PREPAID

DECLARED VALUATION

11

$

DIMENSION OF SHIPMENT

TOTAL CUBIC FEET

TOTAL WEIGHT

TOTAL NO. OF PIECES

In the event of any loss or damage whatsoever, unless a

7

8

0

declared valuation is noted, the carrier shall be liable for the

0

lesser of:

(i) $2.00 per pound of the weight of the item damaged or

lost or,

UNCRATED MERCHANDISE CARRIED AT

PERSONAL EFFECTS TO BE PREPAID AT

(ii) the actual value of the goods.

OWNERS RISK OF DAMAGE

OWNERS RISK OF DAMAGE

CHARGES

MARK WITH “X” TO DESIGNATE DANGEROUS GOODS AS DEFINED IN THE DEPARTMENT OF TRANSPORTATION REGULATIONS.

RATE

CLASS______________________________________ PIN________________________________ PG________________________________

13

12

EMERGENCY 24 HR. PHONE NUMBER REQUIRED ON ALL DANGEROUS GOODS SHIPMENT. PH.

PLACARDS REQUIRED

PLACARDS SUPPLIED

COD

YES

NO

TYPE OF PLACARD:

YES

NO

OTHER

NOTICE OF CLAIM

a) No carrier is liable for loss, damage or delay to any goods carried under the Bill of Lading unless notice thereof setting out particulars of the origin, and date of shipment of the

GST

goods and the estimated amount claimed in respect of such loss, damage or delay is given in writing to the originating carrier or the delivering carrier within sixty (60) days after

the delivery of the goods, in the case of failure to make delivery, within (9) months from the date of shipment.

PRINT FORM

TOTAL

b) The final statement of the claim must be filed within nine (9) months from the date of shipment together with a copy of the paid freight bill.

SHIPPER

PICKUP

CONSIGNEE

DELIVERY

14

15

16

17

UNIT

UNIT

SIGNATURE

DRIVER

SIGNATURE

DRIVER

PRINT NAME

PRINT NAME

DATE

DATE

TIME

TIME

PER

PER