索赔申请表(中英文)V2.0
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中外运-敦豪国际快件有限公司
申请赔偿表
致: 中外运-敦豪国际航空快件有限公司客户服务部日期: _____________
联系人 : ___________(请填写中外运-敦豪国际航空快件有限公司相关联系人姓名)
电话: 800-810-8000
传真: 800-810-8996
申请人姓名: ______________________________ 联系电话: ____________________
公司名称: __________________________________ 公司邮箱地址:_________________ 公司地址: ______________________________________________________________
DHL帐户号码: ______________________________________________________________
DHL运单号码: _________________ 发件地: ______________ 收件地: _____________
件数: _________________ 重量: _______________ 所付运费: ____________
发件日期: _________________ 快件内容: __________________________________
赔偿类别 (请圈出适用者)
遗失: ___________ 部分遗失: ___________ 损毁: ___________ 部分损毁: ______
其他: ___________________________________________________________________
报关总额: ____________________ 投保金额:
所付保险金:要求赔偿总额:
是否在其他保险公司就此快件进行了投保: ___________
分项列举索赔项目索赔金额 (人民币 / 美元)
______________________________________ ______________________________________
______________________________________ ______________________________________
______________________________________ ______________________________________
______________________________________ ______________________________________
现本人 / 本公司 / 申请人声明上述所填之资料属实并正确无误。
申请人签字
__________________________
请将填妥的表格以及所需的价值证明文件(发票等)提交。
DHL-SINOTRANS CO. LTD
CLAIM FORM
To: Customer Care Officer Date: __________________ Customer Service Department
DHL-Sinotrans Ltd.
Contact Person in DHL-Sinotrans: ___________
Tel : 800-810-8000
Fax: 800-810-8996
Claim submitted by: ________________________ Tel no: ___________________________ Company Name: _______________________ Company Email Address___________________ Company Address: ______________________________________________________________ DHL Account No: _______________________________________________________________
Hawb No: _________________ Origin: _____________ Destination: _________ Pieces: _________________ Weight: _____________ Freight Charge: _________ Shipment Date: _______________ Shipment Contents: ______________________________
Reasons for claim (please tick the reasons below)
Lost : ____________ Partial lost : ___________ Damage:__________ Partial damage: _____ Others:__________________________________________________________________________ Total declare value: _____________________ Insured Value________________________ Insurance Premium ______________________Total amount claimed: _________________
Any other insurance on this shipment: ___________
Items need to be claimed Amount claimed (RMB / USD)
______________________________________ ______________________________________
______________________________________ ______________________________________
______________________________________ ______________________________________
______________________________________ ______________________________________
I declare the above information is true and correct.
Signature of Applicant
_________________________
Please fill up this form accordingly and attach the document in support of the amount claimed e.g. invoices, receipts, etc.