CLAIM LETTER To: /, ° i(2- (Ocean Carrier per Bill of Lading) Claim is being made in connection with the following described shipment: Bill of Lading No.: Shipment No.: Vessel: \) iCToR iA 57-A' 19-ir Voyage No.: 00/6 Voyage Date: 11-12-10 Shipper: 2-- Consignee: This Claim for USD$ / is made for: El Damage Shipment Commodity Description: OJt-4A Date and place damage or loss was first discovered: /071/0 rrr c2_ 8RitE G.,0A00 Loss Retina V 044-4 Itemized Statement Showing How Amount Claimed is Determined (Number and description of articles, nature and extent of loss or damage, invoice price of articles, etc.) Quantity Description of Item(s) Damaged / Loss $ Invoice Per Item $ Total Invoice 8 c4.4..J._. 11-44.11 316: 0299 '9 iv"' t..---- 02402,8o I i--- ,-- „2 Pg, ta Total Amount of Claim glee 52 Additional Comments / Items The followin documents are required to support this claim: Ocean Bill of Lading 4 Photos of damaged goods Delivery Receipt Invoices Other Relevant documentsfinfomation Per aistomer Cargo Claim Procedures The foregoing statement of facts is hereby certified as true and correct. L 6 7 Claimant rnmnanv / Name Street / PO Box ST. .1)1- f1/44-5, 4/ v7" to 20 2— aty / State / Province / Country / Postal Code Email Address Business or Home Phone Number(s) (obile?..ell Phone / Fax Number Prepared by iblAtiv/9- II)/ il ia Print Name / Signature Date Prepared EFTA00606315