Dear Sir/Madam,

Re: Shipment of Household Effects (employee's name)

___________________________________________

Airwaybill (or Bill of Lading) No.

(number)              of              (date)

__________________  ____________________

Further to the comments recorded on the delivery receipt when the above shipment was released by your company, I hereby wish to file a notice of intent to claim for the following losses and damage incurred:

Item

____________________________________________________________

Nature of damage/loss

____________________________________________________________

Preliminary estimated cost of replacement or repair

____________________________________________________________

* In view of the amount of damage/loss incurred, I have requested my employer to engage the services of an insurance adjuster and a copy of this report will be available shortly.

** It would be appreciated if your representatives would let me know what further action I must take and the extent of your company's liability in this matter.

If you are refusing any or all liability because of the condition of the shipment when it was received by you, I request that you provide me with a copy of the transfer document recording the condition so that I may pursue this claim with the previous carriers.

Yours sincerely,