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BACK- Use for reporting APPARENT LOSS OR DAMAGE (679) (11-35) (Printed in U.S.A.) RAILWAY EXPRESS AGENCY INCORPORATED REPORT OF SHIPMENT OFFERED FOR DELIVERY IN APPARENT BAD ORDER Office________________________________________Date___________________19_____ The following described shipment was offered for delivery in APPARENT BAD ORDER and was *accepted by consignee. refused Consignee________________________________________________________ Address__________________________________________________________ Shipper__________________________________________________________ Address___________________________________________________________ Waybill Date of Time AM Number_______________________Waybill____________________Delivered___________________PM No. Pieces Declared Description_____________________________________________Value $________________________ Note below, full description of Goods and Nature of Bad Order ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Prepare this report in duplicate. If ship- ment is accepted, give consignee original _______________________________ report. If shipment is refused on account Signature of Deliveryman of condition send original report to shipper. In either case retain duplicate for office record. ________________________________ Signature of Consignee NOTE: This is not a Claim This is an inspection report and does not indicate claim has been entered. Any claim on this shipment must be presented in writing within 9 months from date of delivery as per conditions of the Express Receipt- otherwise claim will be outlawed.
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