Claim Form

Customer Claim Form

Customer Name:*
Company Name:
Address:
Phone No:*
Email ID:

Date:*
Branch:*
GC No:*
GC Date:
Gen.DairyNumber:

Booking Branch:
Delivery Branch:

Booking Amt:
Claim Type:
No.of Pkgs

SNO	ItemNo Asper PkgList	Damaged Article	Shortage Article	Declared Amt as Pkg List	* Demand Amount	Remarks	Actions

				Total:

Documents Required:
Reason of claim:		Proposed ClaimAmt:
Action Taken:

Claim Status:
Settled:	Pending:	Under Process:

Settlement Details:
Set.LtrNo.
Set.Date:
Set.Amt
Cs.No:

DataEntry Person:

DataEntry Date: