Delta Cargo Service Failure Claim Form
Air Waybill No.
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Delta Case No.
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Date of Air Waybill
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Claimant's Reference No.
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Goods Delayed/Refund Request Detailed Reason for Claim Amount of Claim
Time/Date Shipped Time/Date Received
All Claims Must Be Filed Within 60 Days of Ship Date
$
Attach original or certified copy of the air waybill Name of Claimant
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Company
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Mailing Address
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City
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State
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Zip
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The foregoing statement of facts is hereby certified to as correct
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Signature of Claimant or Claimant's Representative
Date
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Job Title of Claimant's Representative
Complete This Form And Mail Original Or Fax To: Delta Cargo Cargo Claims P. O. Box 20559 Atlanta, GA 30320-2559 Phone: 404-714-4541 Fax: 404-714-5022
Copy to: Claimant's File
Reset Form
INSTRUCTIONS FOR COMPLETION OF CLAIM Please include the following information when faxing or mailing in your claim. The more information you provide, the more quickly your claim will be settled. AIR WAYBILL - This is Delta’s form used to document the shipment of cargo and related information. The eight digit air waybill number is in the upper right hand corner and across the bottom of this document. AIRLINE CASE NO - This is an internal reference number that will be assigned by the carrier. CUSTOMER REF. NO. - This is an internal reference number that may be assigned by the customer. CLAIMED AMOUNT - List the damaged or missing merchandise by item and quantity. Tell us exactly what was damaged and how you determined your claim amount. For Loss or Damage: WT. OF DAMAGE/LOSS - List how many pounds/kilograms of the damaged or missing carton(s). INSPECTION REPORT - If loss or damage was noted at destination, the airline agent should have been requested to prepare this report. If an inspection was not completed, please note on the claim form. Inspections by independent surveyors may be included. INVOICE - Provide the original vendor’s invoice for the loss or damaged merchandise to indicate the value of the goods claimed. PACKING LIST - This would list the quantity and weight of the items in each box. For personal effects shipment, the value of each item should also be listed. REPAIR OR PARTS REPLACEMENT BILL - If the damaged goods are repairable, provide the estimate or receipt for repair from an established repair facility. SALVAGE VALUE - Explain what was done with the damaged shipment including the monetary amount recovered. Upon receipt of this claim and supporting information, an acknowledgment will be sent advising of any other documents that may be required. In the interim, your patience is appreciated. FREIGHT FORWARDERS AND INSURANCE COMPANIES In addition to the above, please include: HOUSE AIRBILL - Delivery record copy. SETTLEMENT DRAFT - Proof of payment to ultimate consignee. SUBROGATION RECEIPT - Statement from payee authorizing you to act on behalf of shipper or consignee.