LSO Claim Form

Account Holder Information (Claimant)
Account Number*
Your account number is required to process your claim.
Contact Name*
Company Name*
Phone Number*
Email Address*
On the Label: Shipper’s FROM Information
Contact/Attn Name*
Phone*
Company Name*
Shipper's Address*
Street Address Address Line 2 City State ZIP Code
On the Label: Recipient’s TO Information
Contact/Attn Name:*
Phone*
Company Name
Recipient’s Address*
Street Address Address Line 2 City State ZIP Code
Package(s) Information
Airbill/Tracking Numbers:*
Ship Date*
Date Format: MM slash DD slash YYYY
Declared value on airbill:
LSO maximum liability for any loss, damage, delay, misdelivery, nondelivery, misinformation, or failure to provide information is limited to the declared value of $100, unless a greater and verifiable amount is declared on the manual airbill or submitted electronically for the package at the time of tender and an additional fee paid for such value.
Reason for Claim
Claim Reason*
- Missing/Lost package*
- Damaged Package**
*Claims involving missing packages must be submitted within 30 days. **Claims for damaged packages must be received within 15 days, All packing materials must be kept and remain available for inspection at any time until the claims process has been completed.
Contents of package(s)*
Please describe the damage to the package:*
Amount of Claim*
The following are attached*
- Select All
- Original Purchase Invoice
- Bank/Financial Statement
- Estimate/Invoice for Repair
- Copy of Airbill
Upload a copy of your invoice, bank statement, invoice for repair, airbill*
Drop files here or
Any additional comments or information
Important Notes
Within 90 days, the claimant must provide documentation as required by the LSO Service Guide or as otherwise requested by the Damage and Claims Committee. For additional information about the claims process, requirements and limitations, refer to the current LSO Service Guide.
Claimant Signature*
Date*
Date Format: MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Account Holder Information (Claimant)

On the Label: Shipper’s FROM Information

On the Label: Recipient’s TO Information

Package(s) Information

Reason for Claim

Important Notes