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  • Form Claim Sentral Cargo

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    Drack One
    20 views2 pages
    This claim form provides details of a shipment that was partially damaged during transport. It includes information such as the receipt number, sender and receiver names, origin and destination, date of delivery, weight and type of goods, number of packages, transport method, date and details of the loss, amount claimed, and documents attached. The claimant declares that the statement is truthful and provides a signature.

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    Original Title

    form claim Sentral Cargo (2)

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    This claim form provides details of a shipment that was partially damaged during transport. It includes information such as the receipt number, sender and receiver names, origin and destination, date of delivery, weight and type of goods, number of packages, transport method, date and details of the loss, amount claimed, and documents attached. The claimant declares that the statement is truthful and provides a signature.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    20 views2 pages

    Form Claim Sentral Cargo

    Uploaded by

    Drack One
    This claim form provides details of a shipment that was partially damaged during transport. It includes information such as the receipt number, sender and receiver names, origin and destination, date of delivery, weight and type of goods, number of packages, transport method, date and details of the loss, amount claimed, and documents attached. The claimant declares that the statement is truthful and provides a signature.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 2

    CLAIM FORM

    FORMULIR KLAIM

    Data Resi Sentral Cargo :


    1. Receipt Of Number : 00100180630
    Nomor Resi
    2. Sender : Ully Bonsai
    Nama Pengirim
    3. Receiver : Apri Dwidyo Kuncoro
    Nama Penerima
    4. Origin : Jakarta Barat
    Asal
    5. Date Delivery : 09 Agustus 2023
    Tanggal Pengiriman
    6. Destination : Ponorogo
    Tujuan
    7. Recipient Date :11 Agustus 2023
    Tanggal Penerima
    8. Weight : 5 Liter
    Berat Asli
    9. Type Of Goods : Pupuk Organik
    Jenis Barang
    10. Number Of Collies :1
    Jumlah Koli
    11. Via : Cargo
    Jalur

    Loss Details / Detail Kerugian :


    1. Date Of Loss : 10 Agustus 2023
    Tanggal Kerusakan/kehilangan
    2. Item Condition : Lost Some Partially Damaged
    Kondisi Barang Lost Full Completely Damaged

    3. Amount Of Loss : Rp 107.000,00


    Nominal Kerugian
    Customer Base for Claims related to lost or damaged goods:
    Dasar pelanggan untuk klaim terkait dengan barang yang hilang atau rusak
    ………………………………………………………………………………………………………………………..
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    Documents Attached / Dokumen Terlampir :


    (Contoh:Invoice,Nota,Foto,Video,Resi)
    1. ………………………………………………………………………………………………………………

    2. ………………………………………………………………………………………………………………

    3. ………………………………………………………………………………………………………………

    4. ………………………………………………………………………………………………………………

    5. ………………………………………………………………………………………………………………

    6. ………………………………………………………………………………………………………………

    Declaration / Pernyataan :
    I/We declare that the above statement is made truthfully
    Saya / Kami menyatakan bahwa pernyataan diatas dibuat dengan sebenar-benarnya

    Jakarta,..........................2021

    Signature / Stamp :
    Tanda Tangan / Stempel :

    Name :
    Nama

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