Post Office Claim Form
Claim Information
Package Recipient’s Name
First Name
Last Name
Shipment Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Number of Lost Packages
Number of Damaged Packages
Number of Packages Shortage
Description of Items
Amount of claim
Less salvage value of damaged goods
Less amount paid by the postal service
Balance to be paid by the insurance plan
Shipper's Contact Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
Submit
Should be Empty: