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Home > Doing Business with Us > Customer Service > Submit a Claim > Claim Form

Loss and Damage Claim Form


Please Complete the Application Form

You can use the "Tab" key to move quickly to the next input field as you fill out the form.

If the shipment is damaged and valued at over $500, or you require assistance completing this form, please call 1-800-461-0540.

 

Retain all damaged freight and packaging until claim is finalized. Please note that all claims will be evaluated pursuant to Purolator's Terms and Conditions. Click here to see Purolator's Terms and Conditions for more details.


* = Required fields

Claimant - Account No.

Claimant - Account No.

First Name*

Last Name*

Company (IF APPLICABLE)

Address (No. and Street)*

City *

Province/State

Postal Code/Zip Code *
Country
   

Telephone*
- - ext:

E-mail*

Your Reference Number (OPTIONAL)

Location of Damaged Shipment (IF APPLICABLE)

Contact Person

Company (IF APPLICABLE)

Address (No. and Street)

City

Province/State

Postal Code
Country
    

Telephone - - ext:


Sender

First Name*

Last Name*

Company (IF APPLICABLE )

Address (No. and Street)*

City*

Province/State

Postal Code *
Country
    

Telephone*
- - ext:


Receiver

Contact Person*

Company (IF APPLICABLE)

Address (No. and Street)*

City*

Province

Postal Code*
Country
    

Telephone*
- - ext:


Reason for Claim

One of the 3 must be filled in.

Lost Parcel(s)

Damaged Parcel(s)

Item(s) Lost from Damaged Parcel(s)

Amount Claimed* $ If the shipment is damaged and valued over $500, please call 1-800-461-0540.

Our Trace Reference Number

Pin No./ Parcel Identification Number(s)*

Date shipment sent (DD/MM/YY)*

/ /

Please provide brief description
(Example: colour/weight/dimensions/manufacturer/model/serial no./part no.)

At this point you may print your application by clicking on the print icon in your browser.

Please remember, In order to expedite your claim, please:

Submit the following with your claim(s).

  1. A copy of the original Purolator Bill of Lading or Manifest
    (obtain from sender).
  2. A copy of the original Cost Invoice verifying the claimed amount. This invoice should indicate the actual breakdown of costs claimed. These costs should reflect only your wholesale/manufacturer’s costs and should not include retail markup/profit.
  3. A copy of Damaged Inspection Report (if applicable).
  4. A copy of the Repair Bill (if applicable).
  5. Any other relevant supporting documentation.

Options on submitting your supporting documentation.

  1. Fax: 1-800-447-6933

  2. E-mail: claims@purolator.com

  3. Mail:
    Purolator, National Claims Office,
    1234 Main Street
    7th Floor
    Moncton, NB
    E1C 1H5
    1-800-461-0540

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