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["COMPLAINT FORM"]
[]
["CLAIMANT NAME AND ADDRESS"]
[]
[]
[]
[]
[]
["VAT no."]
[]
[]
["CONTACT PERSON",null,null,null,null,"ARECIPIENT ADDRESS"]
[]
[null,"Name:",null,null,null,null,null,"Schenker sp. z o.o."]
[null,"Position",null,null,null,null,null,"Zwirki and Wigury str. 16 C"]
[null,"Contact number",null,null,null,null,null,"09-092 Warsaw"]
[null,"E-mail address"]
[null,null,null,null,null,null,"VAT No.","527 010  38 24"]
[]
["Shipment reference number :"]
[]
[]
["Description of the complaint:",null,null,null,null,null,"total loss of the shipment"]
[null,null,null,null,null,null,"partial loss of the shipment"]
[null,null,null,null,null,null,"damage of the shipment"]
[null,null,null,null,null,null,"delay"]
[null,null,null,null,null,null,"Errors and omissions (please specify)"]
[]
[]
["Claimed amount:",null,null,null,null,null,"Compensation the amount to:"]
[""]
["EUR",null,null,null,null,null,"Name of the customer:"]
[]
["Gross weight of the damaged goods:",null,null,null,null,null,"Name of the Bank:"]
[]
["kg",null,null,null,null,null,"Bank Account Number"]
[]
[]
["Following documents are attached to the complaint:",null,null,null,null,null,"proof of the value of goods"]
[]
[null,null,null,null,null,null,"other documents to support the claim"]
[null,null,null,null,null,null,"documents presenting the size and kind of damage"]
[null,null,null,null,null,null,"power of attorney if the claim is placed by unauthorized person"]
[]
["Signature of person lodging the complaint:"]
["Date:"]
[]
["ADDITIONAL NOTES:"]