Claims Form

PLEASE NOTE
THERE IS A 30 DAY TIME LIMIT TO COMPLETE AND SUBMIT YOUR CLAIM FROM DATE OF DELIVERY.

  1. No carrier is liable for loss, damage or delay to any goods unless the statement of claim is received by the carrier within the stated time limit.
  2. If DAMAGE claim do not proceed with repairs, replacement or disposal as carrier reserves the right to inspect all items and to appoint repair firm(s) if required.
  3. If LOSS claim describe item(s) in detail, where and when last seen. Give name of present occupant of former residence or name/phone number of Landlord/Real estate broker.
  4. Attach copies of original receipts, appraisals where possible. If additional space required, attach separate sheet to claim form.
  5. AMJ Campbell retains salvage rights.
  6. AMJ Campbell reserves the right to require notarized statements or affidavit.
  7. BILL OF LADING CHARGES MUST BE PAID IN FULL PRIOR TO CLAIM SETTLEMENT.

Contact Information
First Name
Last Name
Street
City
Province / State
Home Phone
Business Phone
Fax
Email Address

Moving Information
Order Number
Tag Lot Number
Tag Colour
Valuation
Origin Address
Date Loaded
Date Delivered

Item Details

1
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount
2
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount
3
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount
4
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount
5
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount
6
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount
7
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount
8
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount
9
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount
10
Item Description
Damage Description
Missing
Tag #
Age (yrs)
Purchase Price
Repair/Claim Amount

* If claiming more than 10 items, please click here to download a PDF claim form for you to manually fill out and return to our office.

Additional Notes

I solemnly swear that the information on this claim form and in my exhibit(s) is true and complete to the best of my knowledge and belief. No material fact is withheld that should be included and this is a complete and accurate statement of all loss and/or damage to be claimed in connection with this shipment. Failure to accept all terms and conditions will cause return of form.