TNT CLAIM FORM

All claims are subject to the terms stated in the TNT Terms & Conditions of Carriage. This claim form does not constitute admission of liability by TNT. Consignment Note: TNT Account No.: 086620

PARTICULARS OF CLAIMANT
Company Name: ANTAR NASIONAL Contact Person: Mr. Yudi Contact No.: (O) +62.22. 2014785 (M) (F) +62.22. 5409342 Email:yudi.translink@gmail.co m Address: JL SARIJADI 23 NO.71 BANDUNG 40164

CLAIM PAYMENT MODE

Cheque x Deposit into Bank Account Payees Name: CV. ANTAR NASIONAL TRANSLINK Bank Name: MANDIRI BANK Branch: BANDUNG BINACITRA Account No.: 13000-6107705-6

TYPE OF CLAIMS (Please tick ONLY those applicable to you)

Damaged Loss (Shipment not delivered) X Others, please specify: The shipment delay do to was missing for one weeks since 14 - 23 November and founded at EK warehouse Did you purchase Enhanced Liability (EL)?

Missing Contents

Yes

No

CONSIGNMENT DETAILS
Origin: BDO - Indonesia Date of Collection: 09-Nov-09 Did you purchase an insurance, covering you for this incident?
Description of Items Quantity Weight

Destination: Dubai Date of Notification to TNT: 14-Nov-09 Yes

Currency

x
Merchandise Value of each unit

No
Claim Amount

Sample of plastic for exibition

5 box

90 kgs

Usd 52.5

Usd 1000.00,-

The below documents which have been ticked will be enclosed with the claim form Copy of TNT Consignment Note (front and back) Photographs of Damaged Shipment and Packaging Repair Cost Quotes (if damaged shipment can be repaired) Any other supporting documents. please specify:
Please arrange to submit the necessary documents listed above. We also wish to inform you that all necessary documents must be submitted with the claim form to enable your claim to be processed within 30 days. Please note that the list of documents is not exhaustive. Other documents may be requested if necessary.

Commercial / Proforma Invoice Replacement Cost Invoice/Quotes (if claim is for replacing damaged/lost shipment) Salvage Value Quotes (if damaged shipment can be partially salvaged)

DECLARATION

I the undersigned acknowledge that the information provided to TNT is for the purposes of the evaluation of this claim by TNT only. TN acceptance of this Claim Form and/or review of the claim does not constitute an admission by TNT of responsibility or liability for any lo damaged or delay of the subject consignment. Signature & Date Company Stamp