FOR PARCEL INSURANCE PLAN POLICYHOLDERS USE ONLY
US POSTAL SERVICE (USPS) CLAIM FORM
For Lost or Damaged Packages -
INSTRUCTIONS:
1.Complete and mail this claim form no earlier than 30 DAYS and no later than 180 DAYS from shipment date.
2.Attach a copy of your original invoice to the consignee.
3.Attach a copy of the correspondence from the consignee advising you of the loss.
4.If at all possible, attach: A. A copy of the USPS tracer form. The USPS reply is not needed.
We advise filing a tracer for all lost USPS packages whether or not you send a copy to us.
B.A copy of the check from USPS, if you insured part of the value with USPS.
C.A copy of the U.S. Postal Service Delivery Confirmation Receipt, if applicable.
D.For computerized shipping system users only - Copy of shipping system daily report detailing amount of claim insured with PIP.
5.Mail to: PARCEL INSURANCE PLAN, P. O. BOX 66708, ST. LOUIS, MO 63166-6708.
Or FAX to: 314-692-7598 (include all requested documentation)
CLAIM PAYMENT FORM
Insured's Name____________________________________________________________ Policy # _______________________
Address Shipped From:_____________________________________________________________________________________
Consignee's Name __________________________________________________ |
Invoice # _____________________________ |
Date Mailed___________________ |
[ ] Loss |
[ ] Damage |
[ ] Shortage |
Number of Packages _____________ |
You or consignee should hold damaged items in the event they are requested during claim processing.
FAILURE TO RETAIN DAMAGED PROPERTY COULD AFFECT FINAL SETTLEMENT OF THE CLAIM.
Description of Items____________________________________________________________________________________
Amount of claim: Invoice or repair cost of contents lost or damaged, |
$_____________________ |
excluding shipping fees:(Amount cannot exceed value declared upon shipment) |
|
Less amount paid by USPS, if any: |
$_____________________ |
Less salvage value of damaged goods: |
$_____________________ |
Balance to be paid by PIP: |
$_____________________ |
The balance of your unpaid claim will be forwarded to you promptly upon receipt of this completed claim form and
items noted in "2, 3, and 4" of the above instructions.
I certify that the above statements are correct.
Signature______________________________________ Send check to attention of:________________________________
