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File New Claim Graphic Items marked with * are required.
Basic Info:   Shipment Info:   Loss Info:  
Reporting Date*
Shipper* Weight of Damaged and/or Missing Goods*  
Scan Global Reference #*
    Did you purchase All Risk Insurance from Scan Global? Commodity Description
Company Name*    
Address Line 1* Insured Value
Address Line 2 Certificate of Insurance #  
Commercial Invoice Amount*
State   Describe Loss or Damages*
Zip / Postal*    
Contact Name*    
Phone* Shipment Origin  
Fax Shipment Destination  
Email* Current Cargo Location  
Claimant Same as Company Date of Shipment*
Claim Amount*
Claimant Company* Date of Delivery / Anticipated*
Claimant Contact Name* Date of Discovery*
Do You Have Your Own
All Risk Cargo Insurance?*
Email*     Email a copy to
Documents:   Additional Info:  
Packing List*
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Special Instructions, Notes, Comments, Etc.
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Inspection/Survey Report
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Repair Bills/Estimates*
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Commercial Invoices*
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Delivery Receipt
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Police Report
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Terms & Conditions of Submission
All claims should be submitted within the proper time limits. Delay in submitting could preclude consideration of your claim. See Terms and Conditions of Carriage for more detail.
By signing the below, I hereby agree that my electronic signature is the legally binding equivalent to my hand written signature and all statements contained in this claim form are hereby certified as true and correct to the best of my knowledge.
Type Name Here*
(Electronic Signature)
Bill of Lading
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Certificate of Insurance
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Delivery Carrier's B/L or AWB
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Other/Misc. Files
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