CLAIM LETTER This claim for USD$ lD c277. 00 Is made for: ilrliamage ray+ Widdshidct gRokEnt Commodity Description: Date and place damage or loss was first discovered: Loss li th 02013 9:01 A04 Bill of Lading #: MCW/07,23/Y9Shipment Number: I/31362o 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.) Idri/dShi Eld plUS SiilppiN +0 Top/oil -=ip code 33117 4.116.65 fi 61.56 7iicip;ail 511ippic xJp -531171 -to TRO lad 511;pp •et zli eat 0102 Total Amount of Claim in USDOA78.. 00 The following documents are required to support this claim: 1. Delivery receipt(s) 2. Original invoices 3. Bill of lading [ 4. Other relevant information pertaining to shortages or damages 5. For claims exceeding $750.00, photos of damages are needed The preceding statement of facts is hereby certified as correct *** Damaged goods must be retained for presentation at time of settlement *** Please Print Company: .11-14k Sigstaeil Today's Date: Contact: Mr./Mrs./Ms. hi \ 1M NODkit AV E7 Phone: Mailing Address: blal RN3 i-lcor. argsts.3 Fax: City: :1}t(\4.AS i \t[ freD9r1MgEmail: StatelCountry/Zip: Signature: 4/ /Plias EFTA01221722