Claim Intimation Form

Standard form for reporting insurance claims

LOSS / CLAIM INTIMATION

Claimant Company Name

Address Line 1

City, State, ZIP

Tel: +123 456 7890

Policy Information

Policy / Cert No. *

Insurer Name

Shipment Details

Vessel / Conveyance

BL / AWB Number

Cargo Description

Loss Particulars

Date of Loss / Discovery

Place of Loss

Description of Damage (Cause & Extent)

Estimated Loss Amount

Damaged Noted on Receipt?

NOTICE: We hereby hold the carriers / bailees responsible for this loss and have issued a formal notice of claim to them. We request you to appoint a surveyor immediately.

Authorized Signatory

Date:

Claims Procedure

A **Claim Intimation** is the first official step in the insurance claims process. Late notification can lead to claim denial.

Immediate Actions Checklist:

Notify Insurer Immediately
Take Photos of Damage
Preserve Packaging
Hold Carrier Liable in Writing