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Norfolk Southern Intermodal Claim Form

Please complete the fields below to start the Claim process.

You may reference Norfolk Southern Intermodal Rues Circular #2 Section 8 for Damage and Loss to Shipments.
- Required fields are marked with *

Nature of claim
Shortage
Undelivered
Damage
Derailment? Yes No
Was the loss the result of defective equipment? Yes No
Was the car released to bad order status? Yes No

Contact Information
* Claimant:
Company:
Street:
City/State:
Zip:
* Phone:
Fax:
E-mail:
* Car/Container ID:                 Initial:  Number:
Today's date:
Bill of Lading Date (ex: mm/dd/yyyy):
Internal Claim Number:
* Claimed Amount:

* Type of Damage
Vandalism
Water Damage
Load Shift
Foreign Substance
Temperature Failure
Delay
Fire
Theft
Other 		Brief Description:

If damage was caused by defective equipment, choose the location(s) the damage occurred

Supporting Information
Original Invoice:
OS&D Report:
Salvage Receipt:
Salvage Allowance:
Total Loss:
Assignment of rights (if you are not the rail services buyer):
Seal records:
Certificate of destruction:
Ocean bill of lading:
Ingate/outgate receipt:
Excise tax forms (alcohol & tobacco):

Photos
You may attach up to five files. Only jpg, tif, & pdf accepted.
Images taking too long to upload? Try reducing their size with image editing software.

Other Supporting documents/reports

(you may attach up to five)

* Signature

The undersigned being unable to furnish original bill of lading and/or original paid freight bill account lost or destroyed hereby guarantees to protect the Norfolk Southern Corporation and any interest carrier against all loss, damage, cost, and attorney's fee which may result from payment of this claim without surrender of original documents.
The forgoing statement of facts is hereby certified as correct.
Type your name: