For Lost, Stolen or Damaged Parcels Claim Information Sheet · Small Parcel/Cargo Insurance...

SmallParcel/CargoInsuranceBuyer/RecipientAffidavit ClaimNumber:______________

ForLost,StolenorDamagedParcelsClaimInformationSheetBuyers/RecipientsName:_______________________________________________________________StreetAddress/POBox______________________________________City________________________State/Province_____________________Postal/ZipCode___________Country_____________________Phone:______________________________Email_____________________________________________ClaimDetailLost/Damage/Incomplete______________________________________________________________IfItemisdamaged,pleasedescribeandattachpictureofdamage:____________________________________________________________________________________________________________________ Describeconditionofpackage:_________________________________________________________________________________________________________________________________________________SellerInformationName:________________________________________________________________________________Phone:__________________________________Email_________________________________________IherebycertifythatallinformationonthisformisaccurateandtruthfulunderFederalLawandunderpenaltyofperjury,underthelawsofthestateofCalifornia.Thesubmissionofafalse,fictitiousorfraudulentstatementmayresultinimprisonmentofupto5yearsandafineofupto$10,000(18USC1001).Inaddition,acivilpenaltyofupto$5,000,andanassessmentoftwicetheamountfalselyclaimedmaybeimposed(31USC3802).Buyer/RecipientSignature:_______________________________________Date:___________________Warning:Anyfraudulentclaimswillmaketheshipperand/orconsigneeliableforanyprosecutionformailfraudunderthefederalcrimecode.

Shouldtheinsuredand/orshippersubmitafalse,fictitiousorfraudulentstatement,itwillresultintheclaimsbeingdenied.

InsureShip 3211CahuengaBlvd.WestSuite200,LosAngeles,CA90068Phone:(866)701-3654/(818)303-9255Fax:(877)859-5858Email:claims@insureship.com

For Lost, Stolen or Damaged Parcels Claim Information Sheet · Small Parcel/Cargo Insurance...

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Transcript of For Lost, Stolen or Damaged Parcels Claim Information Sheet · Small Parcel/Cargo Insurance...

Mitigated Parcels

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MISSING, DAMAGED OR STOLEN PROPERTY REPORT...74-194 (Rev.8-03/3) MISSING, DAMAGED OR STOLEN PROPERTY REPORT NOTE: If property has been stolen or is lost, destroyed or damaged as a

COLLECTIVE BARGAINING AGREEMENT - Watchdog RIwatchdogri.org/docs/Teacher Contract/Exeter_West... · 2018. 9. 26. · G. Teachers shall immediately report stolen, lost or damaged school

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statelinebgc.org€¦ · 20/08/2020 · I understand that the Stateline Boys & Girls Club is not responsible for lost, stolen, or damaged personal articles. I understand that my