Cargo Loss And Damage Claim Submitted
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1Cargo Claims Department
P O Box 1216
Richmond, VA 23218-1216
FAX # (804) 231-8777
CARGO LOSS & DAMAGE CLAIM SUBMITTED BY
Claimant Name
Claimant Claim No.
Date Prepared
Address
UPS Freight Pro Number
Claim Type:
___ Shortage
___ Damage
City, State, Zip
Contact Name
Phone Number
Remit Address (if different from above)
CLAIM IS MADE WITH UPS FREIGHT ON THE FOLLOWING DESCRIBED SHIPMENT
Consignee
City, State & Zip
Shipper
City, State & Zip
DETAILS OF CLAIM TO SHOW HOW CLAIM AMOUNT IS DETERMINED
Weight of
# Items
Description/Part #
Item/Quantity
Amount
$
$
$
$
Repair Cost
$
Freight
Charges
$
Use separate page if additional room is needed
TOTAL
$
DOCUMENTS REQUIRED IN SUPPORT OF YOUR CLAIM
SHORTAGE:
DAMAGE:
Original or copy of paid freight bill
Copy of paid freight bill
Original invoice or certified copy showing prices
Carrier's inspection report (if completed)
Original invoice or certified copy showing prices
Repair bill or certified copy (if repaired) showing
material used & labor rate per hour
Additional documents (photos, statements, etc.)
Waiver of Inspection form (if completed)
NOTE:
To expedite the handling of your claim, please include the above mentioned documents as your claim WILL NOT BE PROCESSED
until properly supported.
Retain all damaged goods until the claim is concluded. Claims will not be accepted via e-mail.
Do not fax pictures when faxing your claim, send separately referencing the UPS Freight pro number.
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Parent category: Business