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…316: 0299 '9 iv"' t..---- 02402,8o i--- ,-- „2Pg, ta I Total Amount ofClaim glee 52 Additional Comments / Items The followin documents are required to support this claim: Ocean Bill of Lading 4 Photos of damaged goods Delivery Receipt Other Relevant documentsfinfomation Per aistomer Cargo Invoices Claim Procedures The foregoing statement of facts is hereby certified as true and correct. L6 7 Claimant rnmnanv / Name Business or Home Phone Number(s) Street / PO Box (obile?..ell Phone / Fax Number ST…