www.dylt.com

1501 Hughes Way
Long Beach, CA 90810
Tel: 800-468-9999  Fax: 888-845-9251

STANDARD FORM FOR PRESENTATION OF LOSS AND DAMAGE CLAIM

  • Claimant's Number is for your reference number. This number will appear on all correspondence regarding your claim.
  • Carriers Number is the Daylight Transport freight bill number.
To (Name of Carrier): Date:
Street Address: Claimant's Number:
City, State, Zip: Carrier's Number:
This claim for $ __________ is made against your company in connection with the following described shipment for:
Damage   Loss   Shortage
Is merchandise available for salvage?___Yes ___ No
Shipper's Name: Consignee's Name:
Point Shipped From: Final Destination:
Name of Carrier Issuing Bill of Lading: Name of Delivering Carrier:
Date of Bill of Lading: Date of Delivery:
Routing of Shipment Delivering Carrier's Freight Bill No.:
DETAILED STATEMENT SHOWING HOW AMOUNT CLAIMED IS DETERMINED
(Number & Description of articles, nature & extent of loss or damage, invoice price of articles, amount of claim, etc.)
ALL DISCOUNTS AND ALLOWANCES MUST BE SHOWN
   
   
   
   
Total Amount Claimed:  
 NMFC Item No. of commodity lost or damaged:  

The following documents are submitted in support of this claim:
Original bill of lading   Original invoice or Certified Copy
Original paid freight bill or other carrier document bearing notation of loss or damage if not shown on freight bill   Shippers concealed loss or damage form
Carrier's Inspection Report Form (Concealed loss or damage)  
Consignee concealed loss or damage form   Other particulars obtainable in proof of loss / damage claimed:

The foregoing statement of facts is hereby certified as correct.

Date:                                                                                                                                               
Claimant's Name:
Company:                                             Address:                                                              Title :
Signature:

(Note: The absence of any document called for in connection with this claim must be explained. When impossible for claimants to produce original bill of lading, or paid freight bill, a bond of indemnity must be given to protect carrier against duplicate claim supported by original documents.)


NOTICE TO CLAIMANTS

Claimants are required to make use of this form for filing claims with carriers. Claims may be filed with the carrier's agent either at the point of origin or destination of shipment, or direct with the Claim Department of the carrier, and will be considered properly presented only when the information and documents called for on the other side of this form have, as far as possible, been supplied.

Before presenting a claim on account of loss and damage, the following important information respecting claims should be given careful consideration:

  1. The terms under which property is accepted and transported by a carrier are stated on the bill of lading issued by the carrier. Persons intending to file claims should before doing so, examine the terms and conditions under which the property was accepted and transported.
  2. Carriers and their agents are bound by the provisions of law, and any deviation therefrom by the payment of claims before the facts and measure of legal liability are established will render them, as well as the claimant, liable to the fines and penalties by law.
  3. In order that carrier may have an opportunity to inspect goods and thereby properly verify claims, any loss or damage discovered that delivery should be reported to the agent of the delivering line, as far as possible, immediately upon discovery, or within forty-eight hours after receipt of goods by consignee. Concealed loss and damage claims should be supported by an "Inspection Report Form" covering the joint inspection of the loss or damage by consignee and carrier's representative. Disposition of concealed loss and damage claims will be expedited by including "Consignee's Concealed Loss or Damage Form" and "Shipper's Concealed Loss or Damage Form" as supporting documents when claim is filed.
  4. It is a common practice for manufacturers and others to ship large quantities to key points for warehousing and later distribution to surrounding areas. In many instances, the original container is not opened and the contents examined before re-shipment to final destination. When this practice is followed, it is impossible to determine after delivery to final destination whether loss or damage of a concealed nature occurred before or after re-shipping. Motor carriers will settle claims of this nature on basis of mileage prorate from first shipping point to final destination and cooperate and assist claimant in collecting balance of such claims from carriers performing the prior transportation. Consignees can usually expedite settlement by securing initial shipper's and warehouse's cooperation in supplying necessary billing reference so that shipment can be identified in handling with carriers tendering transportation to the distribution point.
  5. Under the provision of Part II of Interstate Commerce Act, it is unlawful for a carrier to charge or demand or collect or receive, any greater or less or different compensation for the transportation of property than the rates and charges so specified through the payment of fraudulent, fictitious or excessive claims for loss or damage to merchandise transported is as much a violation of law as is a direct concession or departure from the published rates and charges.

In this connection, attention is also called to the following important quotation from Section 222(c) of Part II of the Interstate Commerce Act:

"Any person, whether carrier, shipper, consignee, or broker, or any officer, employee, agent, or representative thereof, who shall knowingly offer, grant, or give, or solicit, accept, or receive any rebate, concession, or discrimination in violation of any provision of this part, or who by means of any false statement or representation, or by the use of any false or fictitious bill, bill of lading, receipt, voucher, roll, account, claim, certificate, affidavit, deposition, lease, or bill of sale, or by any other means or device, shall knowingly and willfully assist, suffer, or permit any person or persons, natural or artificial, to obtain transportation of passengers or property subject to this part for less than the applicable rate, fare, or charge, or who shall knowingly and willfully by any such means or otherwise fraudulently seek to evade or defeat regulation as in this part provided for motor carriers or brokers, shall be deemed guilty of a misdemeanor and upon conviction thereof be fined not more than $500 for the first offense and not more than $2,000 for any subsequent offense."

To get it done right, make the right call: 1-800-468-9999