Norfolk Southern Metals Claim Form

Please complete the fields below to start the Claim process.
- 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/Rust
Weight Discrepancy
Foreign Substance
Telescoping
Delay
Theft
Other

Brief Description:

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

Supporting Information

Original Invoice:

Certified origin scale weight:

Certified destination scale weight:

OS&D Report:

Salvage Receipt:

Salvage Allowance:

Total Loss:

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.

* 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.

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