AIFE Cargo Claim Report
(Name & who they are: Shipper, consignee,
Loss Reported By
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Policy Number
Date
-
Month
-
Day
Year
Date
Time of Loss
Accident Location
Police Report
Yes
No
On Scene
At Station
Report #
Reporting Agency
Witness
Loss Facts
What Happened?
Insured Loss Information
Insured Driver Name
Address
Phone
Format: (000) 000-0000.
Passenger in IV
Injured Persons in IV
Make
Model
Year
Color
VIN #
License Plate #
Drivable
Yes
No
Location of Damages
Current Location of Unit
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Was driver under Dispatch?
Yes
No
Loss Information
Load Origination
Load Destination
Type of Commodity
Type of Commodity
If food
Dry
Refrigerated
Frozen
Reefer Load?
Please Select
Yes
No
If yes, is the Reefer still operable?
Yes
No
Tractor Operable?
Yes
No
Trailer operable?
Yes
No
Is all cargo still contained within the trailer?
Yes
No
If No, Explain
Is the load capable of being moved by another unit?
Yes
No
If no, explain
Please upload any additional photographs, documents, or files.
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