Type of Claim

Customer Cargo Claim FormQMWFICH 02_1.0
Type of claim
(check one) / Overland / Air / Sea / Multimodal / Storage / CL Logistics / Other
NoYes / NoYes / NoYes / NoYes / NoYes / NoYes / NoYes
Is hereby filed for
(check one) / Loss / Depreciation / Damage / Delay (time guarantee)
NoYes - partlyYes - full / NoYes - partlyYes - full / NoYes - partlyYes - full / NoYes
KN Reference No.
(Mandatory) / Number (i.e. 2310-9999-201.011)
--.
Waybill No.
(Enter number) / KN House Air Waybill, KN Sea-Air Waybill, FIATA, FCR, FBL, FCT, FWR, BAL B/L, CMR / Date of issuing
Claimant
(claim payable to) / Shipper / Consignee / Other / Specify if other
NoYes / NoYes / NoYes
Company Name / Name of contact
Address / E-mail address
Postal Code / City/Town / Telephone / Fax
Country / Claimant Reference No.
Claimant’s Signature / Date
Title

Supporting statement showing calculation of the amount claimed. Include a description of the items (i.e. size, colour, markings)

Detailed Products Description / Quantity / Product unit cost / Total product cost / Weight per Unit (kg) / Total product weight (kg)
Total of Claimed Products
Any additional amount claimed
(Please specify) / Amount / Specify
Total of Claim
(Mandatory) / Currency (i.e. DKK) / Amount
Type of package
(check one) / Cartons / Pallets / Crates / Other / Specify if other
NoYes / NoYes / NoYes / NoYes
Goods Packed by
(check one) / Shipper / KN / Other / Specify if other
NoYes / NoYes / NoYes
Was the Products
(check one) / New / Used
NoYes / NoYes
Do the Claimed have a Marine/Cargo Insurance
(check one) / Yes/No / If yes, list name of Insurance Broker/Company
NoYes
Do the Claimed have a KN Sure Insurance cover
(NACORA policy) / Yes/No / If yes, state police details
NoYes

DOCUMENTS REQUIRED FOR CLAIM PROCESSING

Please ensure that the following are sent to the attention of the KN Claim Centre, whom reserves the right to request any additional documents not listed below. Insufficient documentation may delay conclusion of the claim.

Inspection report
(i.e. survey, supporting photo) / Attach / Justification if No
NoYes
Waybill
(I.e. KN House Air Waybill, FBL, FWR, BAL B/L, CMR) / Attach / Justification if No
NoYes
Delivery receipts
(With proper exceptions of loss and/or damage noted thereon) / Attach / Justification if No
NoYes
Loading reports
(performed in connection with loading) / Attach / Justification if No
NoYes
Shipping instructions
(Given to KN) / Attach / Justification if No
NoYes
Commercial Invoice
(Insurance does not cover more than actual damage) / Attach / Justification if No
NoYes
Packing list
(Incl. list of weights) / Attach / Justification if No
NoYes
Other documents
(Which may facilitate the adjustment of the claim) / Attach / If yes, list name of other documents
NoYes
All services rendered are subject to the General Conditions of the Nordic Association of Freight Forwarders (NSAB 2000 excluding the liability to sign insurance as per § 27 C 3). Under these conditions Kuehne + Nagel’s liability for loss of, deterioration of or damage to goods is limited to SDR 8.33 per kg and Kuehne + Nagel’s liability for delay is limited to the amount of the freight, but not exceeding SDR 50,000 per order. In connection with storage, Kuehne + Nagel's total liability for damage is limited to SDR 500,000 for any incident of damage occurred (clause 27). Special attention is directed to the stipulations that claims against the freight forwarder are statute-barred after one year (clause 30) and that the lien on goods (clause 14) applies to both current and previous claims. Claims for freight etc. must be honoured regardless of the terms of delivery under the contract of sale or freight agreement (clause 10). Further, any counterclaim or set-off against sums due to Kuehne + Nagel is not permitted.