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ONLINE CARGO CLAIMS
  Enter your claims information below
View Complete Claim Instructions
 
Please complete the claims form below.
If you have any questions, do not hesitate to contact us.

DSI Policy holders: File claims via the DSI Management center. Click here to login
* Denotes Required Fields
Contact Information
Full Name: *
Address: *
 
City: *
State/Province: *
Zip/Postal Code: *
Phone: *  (XXX-XXX-XXXX)
Email Address: *  
DSI Policy Number: *  
Claim Information
Carrier:  *
Consignee Full Name: *
Invoice Number: *
Shipment Date: *    
Date Loss Discovered: *    
Claim Type: * 
Claim Contents & Description: * 
Tracking Number:
Carrier Claim Number:
Carrier Check Number:
Carrier Check Amount: $
Total Amount Of Claim: * $
 
Certification
I hereby certify that all information on this form is accurate and truthful. The submission of a false, fictitious or fraudulent statement may result in imprisonment of up to 5 years and a fine of up to $10,000.00 (18 USC 1001). In addition, a civil penalty of up to $5,000.00 and an assessment of twice the amount falsely claimed may be imposed (31 USC 3802).

WARNING: Any fraudulent claims will make the shipper and/or consignee liable for any prosecution for mail fraud under federal crime code.


 I certify the above is correct
and I have read and understand the
claim instructions above.

 
 
 
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