Ocean Freight Lost Cargo Statement

Shipper Name

Consignee Name

Bill of Lading No.

Vessel/Voyage

Container Number(s)

Port of Loading

Port of Discharge

Date of Shipment

Cargo Description

Cargo Value (USD)

Details of Lost Cargo

Description of Loss (circumstances, discovery, etc.)

Date & Location of Loss

Reported To (Carrier/Agent/Authority)

Steps Taken After Discovery

Declaration

I hereby declare that the above information is correct and complete to the best of my knowledge. This statement is made in connection with the loss of the above-described cargo.

Name & Title

Date