Free Legal Forms
| Claimant for Reduced Price |
|
Date: ____________________________________ Claimant's Name: _____________________________ Address of Claimant: __________________________ ___________________________ Name of Carrier: _____________________________ Address of Carrier: __________________________ __________________________ This claim for $ ______ (_____________________________ & ____/100 dollars) is made against the carrier named above by _________________________, Claimant, for overcharge in connection with the following shipment(s): Description of Shipment: ____________________________ Name and address of Shipper: _________________________ Shipped from ____________________________ to ____________________ Final Destination: ______________________ Routed Via ____________ Bill of lading issued by _______________________ (Company) on the ______________ day of _________________, 19___. Paid freight bill No. _________________ Truck No. _____________ And initials ___________________________, Name and Address of recipient __________________. Nature of Overcharge: __________________________ DETAILED STATEMENT SHOWING HOW AMOUNT CLAIMED IS DETERMINED Number of packages __________________, articles _______________, weight ___________, rate ___________, charges _____________, amount of overcharge ________________ Dollars. Authority for rate or classification 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 by carrier. (___________) 2. Original Paid freight ("expense") bill. (___________) 3. Original Invoice or Certified Copy. (___________) 4. Weight Certificate or certified statement when claim is based on misrouting or valuation. (___________) 5. Other Particulars obtainable in proof of loss or damage claimed: __________. Remarks: ________________________________________________________ ________________________________________________________________ ________________________________________________________________. The above statement of facts is hereby certified as correct. Dated: ________________________________. ______________________________________ CLAIMANT |
Disclaimer: TrialData.com provides general information only and does not provide legal advice of any kind. TrialData.com is not an attorney or a law firm and is not a substitute for an attorney or law firm. If you have a legal question or you determine that legal or other expert assistance are required, you are urged to consult with a duly licensed and competent attorney in your jurisdiction. Use of the information provided and the TrialData.com site is subject to the Terms and Conditions of Use.