SEKO
       

NOTE: ALL COMMUNICATIONS REGARDING A CLAIM, INCLUDING DISPUTED DEBTS AND INSTRUMENTS TENDERED AS FULL SATISFACTION OF A DEBT ARE TO BE SENT IN WRITING TO
SEKO WORLDWIDE
1100 ARLINGTON HEIGHTS ROAD, SUITE 600
ITASCA, ILLINOIS 60143
ATTN: CLAIMS MANAGER
SEKO Shipping No:
Date Shipped:
Other Carrier Bill No:
Claimant Ref. No:

Ship From:
City /State:

Ship To:
City /State:
Weight:

Type of Claim:

Detailed statement Showing how amount claimed is determined: Include number and description of articles, if only a portion of the shipment is lost or damaged, indicate how many pieces in total shipment (i.e. 1 lost out of 10). Clearly describe Nature and extent of damage. Show Actual cost of goods. Show all discounts, allowances & salvage. Indicate amount claimed.
Description Claim $


Is the damaged freight repairable?  
Freight Charges Claimed:

Salvage Value:
Packaged Weight (lbs.):
Total Claim(s) $:


Were outer containers damaged?  
No. of containers damaged:
Extent of damage to outer containers:
Name of individual notified of Loss/Damage:
Carrier Affiliation:
City /Branch Office:
Date Freight Inpected:
Name of individual notified of Loss/Damage:
Carrier Affiliation:
City /Branch Office:


Method of notification:

Check the appropriate supporting documents. If submitting this form online, please scan and e-mail or otherwise attach to this form to prevent processing delays:









Remarks (Explain the absence of any pertinent documentation)


Company:

Person Filing:
Address/P.O. Box:
Telephone No:
City/State/Zip:




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