46 C.F.R. § 502 app Exhibit No. 1 to Subpart O [Section 502.252] of Part 502
Current through March 31, 2024
Claim of __________ under the decision of the Federal Maritime Commission in Docket No. __________.
| Date of B/L | Date of delivery or tender of delivery | Date charges paid | Vessel | Voyage No. | Port of origin | Destination port | Route | Commodity | Weight or measurement | As charged | Should be | Reparation | Charges paid by* | ||
| Rate | Amount | Rate | Amount | ||||||||||||
*Here insert name of person paying charges in the first instance, and state whether as consignor, consignee, or in what other capacity.
| Total amount of reparation $____________________. | |
| The undersigned hereby certifies that this statement has been checked against the records of this company and found correct. | |
| Date ____________________. | |
| ____________________ Steamship Company, Collecting Carrier Respondent, | |
| By ____________________, Auditor | |
| By ____________________, Claimant | |
| ____________________, Attorney | |
| (address and date) |
46C.F.R. 502 app Exhibit No. 1 to Subpart O [Section 502.252] of Part 502