Get Bismarck

Filling out the Bismarck form for loss and damage claims is an essential step in seeking compensation from carriers. This guide provides clear, step-by-step instructions to help users complete the form accurately and effectively.

Follow the steps to fill out the Bismarck form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the name of the carrier, 'Midwest Motor Express, Inc.', in the designated area at the top of the form.
3. Fill in the date on which you are completing the claim.
4. Provide the street address, PO Box 1058, for Midwest Motor Express, along with the city and state (Bismarck, ND 58502-1058).
5. Input your claimant's number as assigned by the carrier.
6. State the amount of your claim in dollars next to the label 'This claim for $'.
7. Detail the nature of the claim by indicating whether it pertains to damage or loss.
8. Fill out the details of the shipment, including the shipper's name, consignee's name, the point shipped from, and the final destination.
9. Include the name of the carrier that issued the bill of lading and the name of the delivering carrier.
10. Specify the date of the bill of lading and the delivery date.
11. Provide the routing of the shipment and the delivering carrier's freight bill number.
12. If applicable, state any particulars if the shipment was reconsigned en route.
13. In the detailed statement section, explain how the amount claimed is determined, including the number and description of articles, the nature of loss or damage, invoice prices, and total claim amount.
14. List the NMFC item number of the commodity that was lost or damaged.
15. Summarize the total amount claimed at the end of the form.
16. Attach supporting documents such as the original invoice or a certified copy, the original bill of lading, and any inspection reports related to the claim.
17. If any document is missing, provide an explanation, along with any required indemnity agreements, if applicable.
18. Certify the accuracy of the statements by providing the date, claimant's name, signature, and any relevant company information.
19. Save your changes, then download, print, or share the completed form as needed.

Start completing your Bismarck form online today for an accurate and efficient claims process.