Customer Claim System
Wed, 17 Jun 2026
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Application Form
Incident Report
Application Details
Reference No.
CL/2026/05/V1/013304
Status
New
Report By
Department
Submitted Date
29-05-2026 05:51 PM
Branch
Others
Date of Incident
*
28-05-2026
Time
Type of Claim
*
Damage
Insured by LineShield?
No
Please download this attachment:
Power of Attorney Attachment
.
Fill it up and upload in field below.
Power of Attorney Letter
*
Loss/Damage Item Name
*
ETHER SOLVENT BP
Details of Loss or Damage Items
*
ETHER SOLVENT BP
Description on How the Loss or Damage Occurred
*
LEAKING
Photo of Damage Item
Gambar Kerosakan/Kerugian
*
File Name | Nama Dokumen
Image Name | Nama Dokumen
Document Description | Penyata Ringkas
{"dateCreated":"2026-05-29 17:51:43.0","doc_upload_image":"WhatsApp Image 2026-05-28 at 3.03.58 PM.jpeg;WhatsApp Image 2026-05-28 at 3.02.55 PM.jpeg;WhatsApp Image 2026-05-28 at 3.01.58 PM.jpeg","createdBy":"roleAnonymous","parent_key":"7f032a43-de67-4ca1-a6d8-5072b0542011","parent_key_2":"","dateModified":"2026-05-29 17:51:43.0","modifiedBy":"roleAnonymous","doc_desc":"","doc_type":"img","id":"edb4f3ba-7fe5-42ec-92c3-30296c17d3e7"}
WayBill/Tracking Number
*
V177868280476001
Invoice Number/Proof of merchandise
*
26/02418
Invoice/Proof of Merchandise Photo
Gambar/Bukti Invois
*
File Name | Nama Dokumen
Image Name | Nama Dokumen
Document Description | Penyata Ringkas
20260529175233627.pdf
{"dateCreated":"2026-05-29 17:51:43.0","createdBy":"roleAnonymous","parent_key":"","parent_key_2":"7f032a43-de67-4ca1-a6d8-5072b0542011","dateModified":"2026-05-29 17:51:43.0","modifiedBy":"roleAnonymous","doc_desc":"","doc_type":"doc","id":"403a55bf-2fd9-4453-94a7-ff4c8ff3c584","doc_upload":"20260529175233627.pdf"}
Customer Name (Full Name)
*
ZULAT PHARMACY SDN BHD
Complainant As
Sender
Sender Name
Contact Number
*
0341072061
Email Address
*
glen@zulatpharmacy.com
Estimated Loss/Amount Claimed
*
487.00
Type of Customer
*
Credit Account
Account Name
Account Holder IC Number / Company Registration Number
Customer Account Number
*
Customer Bank Account
*
Link to Internal Report
Shipment Details
Type of Shipment
Type of Customer
Credit Account
Account Name
Account Code
Insurance Policy Number
*
Insurance
Claim Category
Consignor Name
Consignor Address
Consignor Postcode
Consignor City
Consignor State
Incident Happen at Warehouse?
Receiver Name
Receiver Address
Receiver Postcode
Receiver City
Receiver State
Consignor State
Receiver (Contact No.)
Pickup Date
Origin Branch
Receiving Branch
Delivery Date
Courier Charges (RM)
0.00
Request to Return Damage Item
Damage Item Received
Proof of Receipt
Responsible Staff Details
Staff Name
Staff Id
Verification by HR Department
Status
Remarks
Documentation
Police Report
Incident Report
Manifest/Runsheet
Courier Explanation Letter
Proforma Invoice
Case of Summary Report
Actual Claim Amount
Compensation
Waive Courier Charges
Total
***All the total price are inclusive of GST
Remarks
Finance Dept. Action
Status
*
Payment Details
Payment Date
Paid Amount
0.00
Upload Invoice/Credit Note
Finance Remarks
Payment Details From Insurance
Payment Date
Paid Amount
0.00
Upload Invoice/Credit Note
Rejected Reason
Remarks
Attachment
Application Form
Incident Report
Audit Trail
User
Status
Remarks
Time of Task Received
Task Due Time
Time of Action Taken
Duration Until ActionTaken
ZULAT PHARMACY SDN BHD
New Claim Submitted
30-5-2026 12:00:00 AM
29-5-2026 05:45:21 PM
{"c_remarks":"","user_name":"ZULAT PHARMACY SDN BHD","due_date":"30-5-2026 12:00:00 AM","dept":"customer","time_recvd":"","c_parent_id":"7f032a43-de67-4ca1-a6d8-5072b0542011","c_user_name":"ZULAT PHARMACY SDN BHD","duration":"","time_action":"29-5-2026 05:45:21 PM","parent_id":"7f032a43-de67-4ca1-a6d8-5072b0542011","c_dept":"customer","id":"f11f8557-81db-4f0b-a565-0712e7b694f8","c_status":"New Claim Submitted","remarks":"","status":"New Claim Submitted"}
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