Us Postal Service (Usps) Claim Form
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1FOR PARCEL INSURANCE PLAN POLICYHOLDERS USE ONLY
US POSTAL SERVICE (USPS) CLAIM FORM
For Lost or Damaged Packages -
Revised 08/06
INSTRUCTIONS:
1.
Complete and mail this claim form no earlier than 30 DAYS and no later than 180 DAYS from shipment date.
2.
Attach a copy of your original invoice to the consignee.
3.
Attach a copy of the correspondence from the consignee advising you of the loss.
, attach
4.
If at all possible
:
A. A copy of the USPS tracer form. The USPS reply is not needed.
We advise filing a tracer for all lost USPS packages whether or not you send a copy to us.
B. A copy of the check from USPS, if you insured part of the value with USPS.
C. A copy of the U.S. Postal Service Delivery Confirmation Receipt, if applicable.
D. For computerized shipping system users only - Copy of shipping system daily report detailing amount
of claim insured with PIP.
PARCEL INSURANCE PLAN
5. Mail to:
, P. O. BOX 66708, ST. LOUIS, MO 63166-6708.
: 314-692-7598
)
Or FAX to
(include all requested documentation
CLAIM PAYMENT FORM
Insured's Name____________________________________________________________ Policy # _______________________
Address Shipped From:_____________________________________________________________________________________
Consignee's Name __________________________________________________ Invoice # _____________________________
Date Mailed___________________
[ ] Loss
[ ] Damage
[ ] Shortage
Number of Packages _____________
You or consignee should hold damaged items in the event they are requested during claim processing
.
FAILURE TO RETAIN DAMAGED PROPERTY COULD AFFECT FINAL SETTLEMENT OF THE CLAIM.
Description of Items
____________________________________________________________________________________
cost
Amount of claim: Invoice or repair
of contents lost or damaged,
$_____________________
excluding shipping fees:
(Amount cannot exceed value declared upon shipment)
Less amount paid by USPS, if any:
$_____________________
Less salvage value of damaged goods:
$_____________________
Balance to be paid by PIP:
$_____________________
The balance of your unpaid claim will be forwarded to you promptly upon receipt of this completed claim form and
items noted in "2, 3, and 4" of the above instructions .
I certify that the above statements are correct
.
Signature______________________________________
Send check to attention of:________________________________
Telephone (____)_______________________________ Ext.________
FOR PIP USE ONLY
Email Address: ___________________________________________
AMOUNT: $_______________________
Fax No.
(
)
Date ________________
DATE: _________ BY:_____________
Warning: Any fraudulent claims will make the shipper and/or consignee liable for prosecution for mail fraud under
the Federal Criminal Code.
If we have not responded to your claim within 3 weeks of filing, you may check the status of
your claim at .
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