HWB or FILE NO: _________________________

RELEASE OF RIGHTS / ASSIGNMENT OF CLAIM

Assignment made this _____ day of _______________, ______, at

(city) _____________________, (state/country) ___________________.

We hereby assign, transfer and set over to (company) _______________________,

(city) _________________, (state/country) ______________, as assignee, all our rights, title and
interest in and to the shipment hereinafter more particularly described; also all rights as to all claims for
loss or damage to said shipment, and we hereby jointly and severally agree to hold harmless any and all
carriers against all liability, loss, damage and injury which may be occasioned as the result of payment
to said assignee in accordance herewith, as to said shipment which consisted of

(lading description) _______________________________________,

shipped from (shipper) _______________, (city) ______________,

(state/country)______________, shipped on (date) _______________, consigned to

(consignee)_____________________, (city) ________________, (state/country) ____________,

on MAWB __________________________.

Witness: _________________________ Company: _______________________________

Signature: _______________________________

Title: ___________________________________

(city) _________________, (state/country) ___________