Material Damage Certificate

Sample Template Format of Damage Certificate (Required for Insurance Claim) issued by Transporter / Carriers for material damaged in transit.

All Subject to Mumbai jurisdiction only

Phone : --------                Fax : 022- ------

ABC TRANSPORT CO.

THE MOST TRUSTED NAME IN ROAD CARRIERS

Adm. Office : 14, PVR Road, Mumbai 458 005

Ref. No. ………………..                                                                              Date : ………………

                                                                                                                 Issued from Mumbai

CERTIFICATE

(WITHOUT PREJUDICE)

Being issued to the Consignee,  M/s Rocket Sales Limited

Address :   Corporate House, 19^th floor, 45/5 Nariman Point, Mumbai 458 540

For the goods despatched by  M/s Rocket Sales Limited, Khapoli

Arrived on _________________ vide A/R No. _______________ delivered on _____________

as per the following Consignment Note :-

C. N. No. _____  Dated ______ Pkgs. Booked _____ Pkgs delivered _______ Ex- ____________    To  _______________     Declared Weight ________ Said to contain __________________ GR/CR value _________________ Remarks on C. Note No. _______________________________________________

Invoice No. _______________ Dated __________ Amount _____________

Issued with _______________ Policy No. ___________ Dt. _____________

Outer condition _______________ Inner Condition ____________________

Now this Certificate witnesseth :

Contents	Type of loss i.e. Shortage/Damage etc.	Original Value as per Invoice	Estimate of loss

Total Estimated loss Rs. ___________ (Rupees ________________________  )

            We agree to the above without prejudice, This certificate is issued at the request of the consignees primarily as witness for the purpose of lodging claim with their underwriters of the consignors, without admission of any liability, negligency or default on the part of the Carriers.

Agreed and accepted                                                                         

For M/s Rocket Sales Limited                                                   for ABC Transport Co.

Signature for the Consignees or

their authorised representative                                                    Manager