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UPS Air Freight Guaranteed Service Claim Form Press F1 on any field for help Refund Amount specify currency Date filed Claim Payable To Payer Only UPS Bill of Lading/Air Waybill No Company Name Address Customer Reference No. Customer Account No. City/Town State Country Zip / Postal Code CLAIM MUST BE SUPPORTED BY A DETAILED STATEMENT Description of Claim NOTE Claim should be supported by following documents. Failure to include sufficient documentation may be grounds for denial of your claim and may delay conclusion of the claim. UPS reserves the right to request any additional documents not listed below. Invoice number to which the refund request relates Check number and check name on which the customer s payment was made if applicable Copy of Air Waybill bill of lading or shipping manifest Party filing claim is Shipper Consignee Debtor/Payee Fill in the appropriate box with contact information rd 3 Party The statements contained in this claim form are hereby certified as true and correct. Invoice number to which the refund request relates Check number and check name on which the customer s payment was made if applicable Copy of Air Waybill bill of lading or shipping manifest Party filing claim is Shipper Consignee Debtor/Payee Fill in the appropriate box with contact information rd 3 Party The statements contained in this claim form are hereby certified as true and correct. Claimant s Company Name Tel No. Claimant s Contact Name print E-Mail Claimant s Signature Date Fax No Mail Claim to UPS Air Freight Cargo Claims 9/F 100 Texaco Road Tsuen Wan N.T. Hong Kong Phone No. 852-2942-5174 Fax 852-2942-5770 Email UPSAPACclaims ups. Failure to include sufficient documentation may be grounds for denial of your claim and may delay conclusion of the claim* UPS reserves the right to request any additional documents not listed below. Invoice number to which the refund request relates Check number and check name on which the customer s payment was made if applicable Copy of Air Waybill bill of lading or shipping manifest Party filing claim is Shipper Consignee Debtor/Payee Fill in the appropriate box with contact information rd 3 Party The statements contained in this claim form are hereby certified as true and correct. Claimant s Company Name Tel No* Claimant s Contact Name print E-Mail Claimant s Signature Date Fax No Mail Claim to UPS Air Freight Cargo Claims 9/F 100 Texaco Road Tsuen Wan N*T* Hong Kong Phone No* 852-2942-5174 Fax 852-2942-5770 Email UPSAPACclaims ups. com CLAIM APPROVED APPROVAL SIGNATURE INTERNAL USE ONLY AMOUNT APPROVED CLAIM DENIED DATE GIS form 427A Page 1 of 1 04/08/10 All services are subject to applicable Terms Conditions of service which are available for review at www. ups-scs. com Said Terms Conditions include but are not limited to liability limitations and claim filing requirement. For rules regarding the Guaranteed Service Terms and Conditions see section XVII. Copyright 2009 United Parcel Service of America Inc* All rights reserved.

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