FOR PARCEL INSURANCE PLAN POLICYHOLDERS USE ONLY

US POSTAL SERVICE (USPS) CLAIM FORM

For Lost or Damaged Packages

INSTRUCTIONS

Complete and submit this claim form no earlier than 30 DAYS and no later than 180 DAYS from shipment date for LOST packages.

There is no waiting period for DAMAGED packages, but all claims must be filed no later than 180 DAYS from shipment date.

Claim Form Information

Insured's Name*

Address Shipped From*

Policy Number*

Claim Type*

Loss Damage Shortage

Date Mailed*

Number of Packages*

You or Consignee should hold damaged items in the event they are requested during claim processing.

FAILURE TO RETAIN DAMAGED PROPERTY COULD AFFECT FINAL SETTLEMENT OF THE CLAIM.

Consignee's Name*

Invoice Number

Tracking Number*

Description of Items*

Amount of Claim: Invoice or Repair cost of contents lost or damaged, excluding shipping fees*: (Amount cannot exceed value declared upon shipment)

Less amount paid by carrier, excluding shipping fees*: (Shipping fees should be recovered from the carrier)

Less salvage value of damaged goods*:

Balance to be paid by PIP*:

Send claim check to the attention of*:

Upload a copy of your original invoice to the consignee.*

Upload a copy of the correspondence from the consignee advising you of the loss.*

Upload a copy of USPS tracer form. The USPS reply is not needed.

Upload a copy of the check from USPS, if you insured part of the value with USPS.

Upload a copy of the U.S. Postal Service Delivery confirmation Receipt, if appliable.

Upload a copy of shipping system daily report detailing value of package insured with PIP.

Attachment format can be .jpg, .gif, .png, or .pdf files.

Signature

 Prompt settlement of your claim will be subject to providing all required information requested  on this claim form and any other documentation that is requested to substantiate loss.  Failure to comply will delay settlement.
Warning:  Any fraudulent claims will make the shipper and/or consignee liable for prosecution for mail fraud under the Federal Criminal Code.

By selecting this checkbox and entering my name, I certify that the above statements are correct.*

Type your full name here *

Telephone*

Telephone Ext

Fax Number

Email*

If we have not responded to your claim within 3 weeks of filing, you may check the status of your claim at www.pipinsure.com.

* required field