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    Cargo Claim Form

    Uploaded by

    Zoran Dimitrijevic
    The document is a cargo claim form from an insurance company that collects information about a transport claim, including details of the transported goods, description of damage, documentation required, and procedures for reporting damage based on transport type. It authorizes the insurance company to process personal data and share information with third parties as needed to process the claim. The form must be signed to allow processing of the claim.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Cargo Claim Form

    Uploaded by

    Zoran Dimitrijevic
    245 views2 pages
    The document is a cargo claim form from an insurance company that collects information about a transport claim, including details of the transported goods, description of damage, documentation required, and procedures for reporting damage based on transport type. It authorizes the insurance company to process personal data and share information with third parties as needed to process the claim. The form must be signed to allow processing of the claim.

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    Cargo Claim Form

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    The document is a cargo claim form from an insurance company that collects information about a transport claim, including details of the transported goods, description of damage, documentation required, and procedures for reporting damage based on transport type. It authorizes the insurance company to process personal data and share information with third parties as needed to process the claim. The form must be signed to allow processing of the claim.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    245 views2 pages

    Cargo Claim Form

    Uploaded by

    Zoran Dimitrijevic
    The document is a cargo claim form from an insurance company that collects information about a transport claim, including details of the transported goods, description of damage, documentation required, and procedures for reporting damage based on transport type. It authorizes the insurance company to process personal data and share information with third parties as needed to process the claim. The form must be signed to allow processing of the claim.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    E

    Transport Contract No.

    Cargo Claim Form


    Insured
    Name and Address

    Street

    Place

    Telephone Fax E-mail

    Postal-Account Bank and IBAN

    Transported Goods
    Type of Goods Date

    Voyage from Arrival date

    Type of packing (Description)

    Number of packages Cases on Pallet bags


    Cartons unpacked others

    Type of Transport
    Post sendings Railway Own Vehicle Licence Plate No.
    mode of mailing: Airfreight Third Party Vehicle, Name and address of the Transport Company
    Riverboat
    Seafreight
    Courier service

    Description of Damage
    Place of Damage Date of Damage

    Describe exactly the circumstances and the cause leading to the claim. Which goods were damaged or are missing?
    (weight, number, cases, cartons)

    Approximate claim amount

    Where can the goods be inspected?

    Additional Information
    Was the Transport company held responsible? (Please note time limits of claims)

    yes no, reason

    Was a police report issued?

    no yes, where

    Is there a Transport policy placed with another insurance company?


    411.2006 e 7.15 pdf

    no yes, through Shipper Consignee Forwarding

    Name of Insurance Company,

    Please provide precise and detailed information concerning the claim settlement
    To enable us to process this claim we require the following documentation:
    Copy of the Sales invoice (commercial invoice) Copies of the relevant correspondence
    Original Insurance Certificate, if any photographs, if any
    Copy of the delivery note (with the weight & packing list) Police Report
    Claim calculation sheet copy of dispatch advice (valuables)

    additionally
    MAIL AIR
    Non-delivery notice from the consignee Air Waybill/ House Air Waybill
    Original statement of facts of the Postal Authority Original Non Delivery Certificate from the Airline
    Original Post Office report on the Loss/Damage Original Cargo Damage Report (CDR)
    Settlement of the Postal Authority copy letter of reserve to the carrier and their answer

    ROAD OCEAN/RIVER
    Original Waybill (CMR)/Delivery Note with Original Ocean/River Bill of Lading
    reserves
    For Combined Transport: Original Through Bill of Lading
    Letter of reserve to the Carrier/Freight Forwarder
    and their answer Letter of Reserve to the shipping Agent and their answer

    Certificate of Loss from the Carrier/Freight Forwarder Non-Delivery Certificate

    TRAIN COURIER SERVICE


    Original Rail Bill waybill
    Original statement of facts from the Railway Co. letter of reserve to the courier service and their answer

    Proceedures in the case of transport loss/damages


    Transport by Road Check the number and the condition of the packages/cases together with the delivery driver.
    or courier service Make notes of any irregularities on the transport documents (Delivery Note/CMR Consignment
    Note and insist on a counter signature from the driver of the vehicle.
    Damages discovered after the opening of packages/cases must be reported (by registered letter)
    within 7 days to the transportation company holding them responsible (protection of recovery)

    Shipments by Mail, Within 7 days request a Report of Findings from the carrier and advise the transport company in
    Train & Air: writing holding them responsible.

    Shipments by Sea/River: At latest 3 days after the arrival and/or discharge of the goods the vessel or transport agent must
    be notifield in writing (registered letter) holding them responsible.

    Claims Minimisation: At any time all resonable care is to be taken to minimise loss or damage.

    Information to the Any Claim must be reported immediately to the BASLER in writing.
    Insurers:

    The Assured may not accept any claim for damage or liability without the insurers consent.

    The undersigned authorizes Baloise Insurance Ltd [Baloise Life Ltd] (hereinafter called the Baloise) to process his/her personal
    data in connection with the processing of this insurance claim/benefit case. The Baloise may in particular:

    refer data to involved third parties in Switzerland or abroad (e.g. co-insurer, reinsurer);
    seek recourse from a liable third party (or their liability insurer) and provide them with the relevant data;
    obtain relevant information and access to relevant documentation from private insurers, public authorities, witnesses and
    other information providers.

    The undersigned authorizes the above-mentioned individuals or institutions to provide the Baloise, at the latters request, with
    data required for processing of the insurance claim/ benefit case, and relieves them of their obligation of secrecy for this
    purpose.

    The undersigned also relieves the Baloise of its obligation of secrecy with regard to data that it passes on to third parties in
    connection with the processing of the claim/benefit case.

    , the Signature

    Baloise Insurance Ltd


    Claims Switzerland, Aeschengraben 21, P.O. Box, 4002 Basel
    Phone 00800 24 800 800, Fax +41 58 285 90 73, [email protected], www.baloise.ch

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