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    Claim Forms

    At Carey we strive to make your move as easy as possible, but sometimes items get damaged in transit. Please use this form to send your local/intrastate claim to Carey for processing. You may submit this form on-line (please select the appropriate office) or print it and mail/fax it to the appropriate office:

      Choose A Location:

      Load Date

      Delivery Date

      Origin Address

      Reference Number

      Claim Date

       

      Destination Address

      Type of Coverage

      From... (Please provide us with your contact information and request)

      First Name:

      Last Name:

      Address:

      E-mail:

      Address 2

      Phone:

      City:

      Wireless/Cell Phone:

      State:

      Zip:

      Inventory Item #

      Article

      describe in detail

      Nature of Claim

      describe damage in detail

      Approx. Weight

      Purchase Mo/Yr

      Quant.

      Cost

      Amount Claimed

      Inventory Item #

      Article

      describe in detail

      Nature of Claim

      describe damage in detail

      Approx. Weight

      Purchase Mo/Yr

      Quant.

      Cost

      Total

      The actual cash value of my shipment was: $

      Comments/Questions:

      SCTB, Tariff No. 5 General Rules and Regulations states:

      • Any claim for loss, damage, or overcharge shall be in writing and shall be accompanied by original paid BILL OF TRANSPORTATION and original BILL OF LADING, if not previously surrendered to carrier. Carrier may require certified or sworn statement of claim.

      • Carrier shall be immediately notified of all claims for concealed damage and shall be given reasonable opportunity to inspect alleged damage in original package.

      • All Intrastate claims (Moves within state lines) must be received by the carrier within 90 (ninety) days from date of delivery by said carrier.

      • Interstate claims (Allied Bill of Lading Moves) must be received by the carrier within 9 months from date of delivery by said carrier.

      Certification: By choosing the Agree Buttong button below, I certify I am the owner of the property described and I did not cause or contribute to the damage set forth herein. I also, declare that all statements made in the statement of claim and any attached documents are true and correct to the best of my knowledge and belief, and constitute my complete and entire claim. No material information has been withheld.

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