货物索赔单（样本）

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CARGO ALAIM FORM

10作3-38                                           编号：

                                                      年     月      日

货单号码                                  索赔人联系电话                                  

索赔人姓名                                                                             

索赔地址                                                                                      

索赔事由                                                                               

                                                                                       

                                                                                        

                                                                                       

运输事故签证编号                                                                       

品    名                    件    数                      重    量                     

始发站                      经停站                        目的站                       

货物价值                    运  费                        赔偿金额                     

发生事故的地点和时间                                                                    

受理人                                               

受益人                                               

                                                Serial NO.

此单一式三份，第一联交财务，第二联交受益人，第三联查询留存。