US POSTAL SERVICE (USPS) CLAIM FORM

1 POLICY #15735 US POSTAL SERVICE (USPS) CLAIM FORM For Lost or Damaged Packages Revised 08/20S 1. Complete and sign this CLAIM form. Your signature is required for Attach a copy of your original invoice billing your customer for this Attach a copy of the email or signed letter from the package recipient advising youof the loss or Submit this CLAIM form WITH ITEMS 2 & 3 above using the information to the You must wait 30 days after the shipment date to submit a CLAIM for a LOST package. Claims for DAMAGED packages can besubmitted at any time. All claims must be submitted within 90 days of the shipment package recipient should hold damaged items in the event they are requested during claims processing. FAILURE TORETAIN DAMAGED PROPERTY COULD AFFECT FINAL SETTLEMENT OF THE : Any fraudulent claims will make the shipper and/or package recipient liable for prosecution for mail fraud under theFederal Criminal PIP directly with questions or if PIP has not responded to your CLAIM within 3 weeks of filing at 314 872 Recipient s Name: _____ Shipment Date:_____ Customer ID: _____ Tracking/Confirmation #:_____ CLAIM Type: [ ] LOST [ ] DAMAGED [ ] SHORTAGE Description of Items: _____ Amount of CLAIM (invoice or repair cost excluding shipping fees) Less amount paid by USPS, if any Less salvage value of DAMAGED goods (this does not apply if package is LOST) Balance to be paid by PIP Shipper s Name: _____ Send check to attention of: _____Shipper s Mailing Address: _____ City, State, Zip: _____ Telephone: _____ Email Address: _____ I certify that the above statements are correct.

2 Signature _____ INSTRUCTIONS: Important Notes: CLAIM INFORMATION $ $ $ $ Shipper s Contact Information FOR PIP USE ONLY AMOUNT: $_____ DATE: _____ BY:_____ Send this CLAIM form PLUS items 2 & : or Fax: 314 692 7598 or Mail: Parcel Insurance Plan PO Box 66708 St. Louis MO 63166 6708