Claimant for Reduced Price
Date: ____________________________________
Claimant’s Name: _____________________________
Address of Claimant: __________________________
___________________________
Name of Carrier: _______________Address of Carrier: ________________________
This claim for Rs. ______ (_____________________________ & ____/100 Rupees) is made against the carrier named above by _________________________, Claimant, for overcharge in connection with the following shipment(s):
Description of Shipment: ____________________________
Name and address of Shipper: _________________________
Shipped from ____________________________ to ____________________
Final Destination: ______________________ Routed Via ____________
Bill of lading issued by _______________________ (Company) on the ______________ day of _________________………..
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