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Claim for Damage TO (CARRIER): FROM (CLAIMANT): SHIPMENT FROM: SHIPMENT TO: SHIPMENT BY: SHIPMENT TO: BILL OF LADING #: DELIVERY DATE: As Shipper/ Recipient, we hereby give Notice to you, the Carrier, that the following goods received through described above were found to be damaged: RE F# Q T Y DESCRIPTION OF ITEM DESCRIPTION OF DAMAGE TOTAL CLAIMED VALUE $ Compensation for the above damages is hereby claimed and demanded Such claim does not limit our rights to further claims and damages, in the event additional claims or damages are discovered on account of such delivery Settlement with or release to you does not waive any of our rights against any third party, nor does the same with any third party waive any rights against you All rights are reserved, cumulatively and not exclusively Nothing contained herein shall alter any other documentation issued by us, unless specifically so stated Claimant: by: Authorized Signatory