*State / Province
State / Province
*ZIP / Postal Code ZIP / Postal Code
Fax Fax
Sender or Shipper’s Name / Contact
Company
Address
City
Country
Phone
E-Mail
E-Mail
Customer Reference No.
Contact Name
State/Province
ZIP/Postal Code
I accept that the foregoing statement of facts is hereby certified as correct.
Signature (for fax or mail)
Company/Claimant Name (please print)
Claimant’s Address
City
Country
Email
Fax
Claim Form
For lost or damaged domestic or international shipments
Tracking or Freight Bill Numbers
Salvage/Inspection
Mail or Fax
Shipment Information
Multiple tracking numbers for the same sender, recipient, and ship date allowed (FedEx Ground only).
Not Received
Missing Contents
Damaged
Please retain all packaging and
merchandise untilyourclaimisresolved.
C.O.D.
For FedEx Express
®
and Ground
Only
No. of packages
Ship date
FedEx control number (FedEx Express Only)
(NOTE: Call FedEx Customer Service to obtain a FedEx Express control number.)
Qty of Packages Item # Item Description Claimed Amount
Describe damage to outer packaging
Describe inner packaging
Describe damage to contents
Declared value for
customs
(International shipments only)
Shipping Costs
*Total claim /
C.O.D. amount
Declared value
(The value declared on the
shipment when tendered to FedEx)
Merchandise value
(Original purchase value)
Repair Cost
(include breakdown)
Customer remarks
If your claim is filed for damage, and mitigation through repair or allowance is not possible, please explain why and provide contact information for
salvage pickup. Salvage should be held until investigation of the claim is complete.
Contact Name
Phone Fax
Please return the completed form and required Proof of Value documentation (invoice and/or receipt) to:
FedEx Cargo Claims Dept. P.O. Box 256 Pittsburgh, PA 15230 | Fax Number 1.877.229.4766 | Please e-mail to file.claim@fedex.com
Note: Please indicate currency
used on all values.
Phone
Weight of items claimed
Claimant Information
(Address where correspondence
pertaining to the claim will be mailed)
City
Country
Phone
Recipient's or Consignee's Name/Contact
Company
Address
Date
Email Address
