Waiver Of Inspection Form - Ups Freight

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CARGO CLAIM DEPARTMENT
P O Box 1216 - Richmond, VA 23218
FAX: 866-580-1944
WAIVER OF INSPECTION
Re: PRO No. __________________
Dear Customer,
This is in response to your report of damage on shipment numbered above, dated __________________,
From ___________________________________________________________ (shipper).
It is our understanding that the damaged items are: _________________________________________
_________________________________________________________________________________
and that the invoice value does not exceed $_________________ .
Joint inspection is hereby waived. The waiver is not an admission of liability. We ask that you please
complete this form and mail to the above address. This report IS NOT A CLAIM in and of itself. If a
claim is to be filed, a copy of this report should be attached to your claim when it is sent to our Claims
Department.
Cordially yours,
Signed: ______________________ Terminal: __________________________ Date: _____________
Carrier Freight Bill No.:
Dated:
Date Reported Concealed
Shipper:
Damage to Carrier:
Consignee:
Description of Shipment:
Describe Damage:
_________________________________________________________________________________
1. If damage was noted at the time of delivery, what was the condition of the container that indicated the
loss or damage occurred while in the possession of the carrier? ______________________________
__________________________________________________________________________________
2.
Was the damaged merchandise moved, after delivery by the carrier, to some other place before damage
was discovered?
Yes
No
If yes, please explain: ________________________________________
3. Container was:
Do you think freight was properly packed?
Yes
No - Explain
Cardboard
Wooden
4. If the carton was in good condition at the time of delivery and the damage was not noted until unpack,
how would you determine who is responsible for the damage?
________________________________________________________________________
Please explain:
5. Did you see anything about the way the material was packed or manufactured that would indicate who
is responsible for the damage?
________________________________________________________________________
Please explain:
I hereby certify the above statements made by me are true.
_______________________________ _______________________________
________________
Signature of Consignee
Title
Date
CLAIMS RESULTING FROM FAULTY PACKING OR DEFECTIVE MANUFACTURE
SHOULD BE FILED WITH THE SHIPPER
This report is merely a statement of facts and NOT AN ACKNOWLEDGMENT OF CARRIER'S LIABILITY.
If a claim is to be filed, it must be filed in writing promptly, in any event within 9 months from the date
of the delivery.
OTC-018 (Rev. 10/10)

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