46 CFR Appendix Exhibit No. 1 to Subpart O of Part 502 - Exhibit No. 1 to Subpart O [§ 502.252] of Part 502—Reparation Statement To Be Filed Pursuant to Rule 252
prev | next
Exhibit No. 1 to Subpart O [§ 502.252] of Part 502—Reparation Statement To Be Filed Pursuant to Rule 252
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 ________________________________________, |
|
________________________________________, |
|
(address and date) |