Claim Form

Presentation of Loss and Damage Claim
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • QuantityDescriptionAmount 
    Please include quantity, item #, nature and extent of the loss. All discounts and allowances must be shown. Please click the PLUS button on the right to add more rows.
    Please check the fields in which you have provided the appropriate document for (see below). Any claim received without this document is subject to denial based on NMFC Item #300110.
  • Drop files here or
    Accepted file types: jpg, png, pdf, jpeg, docx, Max. file size: 10 MB, Max. files: 5.
    • Drop files here or
      Accepted file types: jpg, png, pdf, jpeg, docx, Max. file size: 10 MB.
      • Drop files here or
        Accepted file types: jpg, png, pdf, jpeg, docx, Max. file size: 10 MB.
        • Drop files here or
          Accepted file types: jpg, png, pdf, jpeg, docx, Max. file size: 10 MB.