Rejected Reason

Remarks

Attachment

Date of Incident
Tarikh Kejadian *

Time
Masa

Type of Claim
Jenis Tuntutan *

Damage | Kerosakan Lost | Kehilangan Missing Content | Tiada Kandungan Short Piece | Tidak Lengkap Damage due to FreshBox Delay Delivery | Kerosakan disebabkan Kelewatan Penghantaran FreshBox Delay Delivery for Premium Parcel | Kelewatan Penghantaran untuk Bungkusan Premium

Insured by LineShield?
Diinsuranskan oleh LineShield?

Yes | Ya No | Tidak

Please download this attachment / Sila muat turun dokumen ini : Power of Attorney Attachment.
     Fill it up and upload in field below / Lengkapkan dan muatnaik semula di bawah.

Power of Attorney Letter
Surat Kuasa Wakil *

Drop files here or click to upload.

• remove

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Loss/Damage Item Name
Item yang Rosak/Mengalami Kerugian *

Details of Loss or Damage Items
Butiran Kerosakan/Kerugian *

Description on How the Loss or Damage Occurred
Keterangan Kejadian yang Menyebabkan Kerosakan/Kerugian *

Photo of Damage Item | Gambar Kerosakan/Kerugian

Document Type
Jenis Dokumen *

Document (PDF, Word, Excel) Media (Image, Video)

Image Name | Nama Dokumen *

Drop files here or click to upload.

• Remove

File Name | Nama Dokumen *

Drop files here or click to upload.

• remove

Document Description
Keterangan Dokumen

Please be advised to include only one waybill number per request.
Anda diingatkan untuk hanya memasukkan satu nombor Waybill/Transaksi untuk satu tuntutan.

WayBill/Tracking Number
No Waybill/Transaksi

Invoice Number/Proof of merchandise
No Invois/Bukti Urusniaga *

Invoice/Proof of merchandise Photo | Gambar Invois/Bukti Urusniaga

Document Type
Jenis Dokumen *

Document (PDF, Word, Excel) Media (Image, Video)

Image Name | Nama Dokumen *

Drop files here or click to upload.

• Remove

File Name | Nama Dokumen *

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• remove

Document Description
Keterangan Dokumen

Customer Name (Full Name)
Nama Pelanggan (Nama Penuh) *

Complainant As
Yang Membuat Aduan

Receiver | Penerima Sender | Pengirim

Sender Name
Nama Pengirim

Contact Number
No Telefon *

Email Address
Alamat Email *

Estimated Loss/Amount Claimed
Anggaran Kerugian/Jumlah Dituntut *

Type of Customer
Jenis Pelanggan *

Credit Account | Akaun Kredit Prepaid Account | Akaun Prabayar Cash | Tunai

Account Name
Nama Akaun *

Account Holder IC Number / Company Registration Number
No IC Pemegang Akaun / Nombor Pendaftaran Syarikat *

For company account, please fill in company registration number.
Bagi akaun syarikat, sila isikan nombor pendaftaran syarikat.

Customer Account Number
No Account Pelanggan *

Customer Bank Account
Nama Bank Pelanggan * - Please Select - Alliance Bank UOB Bank CIMB Bank Agro Bank Al-Rajhi Malaysia Bank Simpanan Nasional Bank Islam Standard Chartered Bank MBSB Bank Maybank Bank Rakyat Affin Bank AmBank Hong Leong Bank RHB Bank CitiBank Public Bank HSBC Bank Bank Muamalat CIMB Bank OCBC Bank

Captcha *

Please fill in the captcha before proceed. You can click the picture to generate a new captcha.
Sila masukkan captcha sebelum menghantar permohonan. Sila klik pada gambar untuk menghasilkan captcha yang baru.

Actual Claim Amount

Compensation

RM 1 - RM50 RM 51 - RM 100 RM 101 - RM200 RM 201 and above

Waive Courier Charges

Yes No

Total

***All the total price are inclusive of GST

Remarks

Payment Details

Payment Date

Paid Amount

Upload Invoice/Credit Note

Drop files here or click to upload.

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Payment Details From Insurance

Payment Date *

Paid Amount *

Upload Invoice/Credit Note *

Drop files here or click to upload.

• remove