Claim Request Form Version 1.

CLAIM REQUEST FORM

TO BE COMPLETED BY SENDER/SHIPPER (only)

Handover Date : Submission Date :

Sender/Shipper’s Details :
Name /
Company Name

Address

Contact
Email Address
Sending Drop Point

Receiver/Consignee’s Details :
Name

Address

Contact

Claim for : ( Missing Pieces / Damage / Lost / Other : )

(Please circle one of them)

Shipment details as below :

AWB No.
Qty Item Description Amount to Claim

Purchase with J&T Insurance : ( Yes / No )

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Claim Request Form Version 1.0

Please complete the following questions :-

1) When are you made aware of the parcel being Damaged or Lost?
2) Did you contact J&T Malaysia immediately? ( Yes / No ) (Please circle one of them)
If not, please specify the reason for delay:

Please describe damage to outer packaging/contents :

3) Did you declare that the parcel is high value item(s)? ( Yes / No ) (Please circle one of them)
4) Were you recommended to purchase insurance? ( Yes / No ) (Please circle one of them)
5) Did you self prepare the packing of the item(s) before handing over to J&T Malaysia? ( Yes / No )
(Please circle one of them)
If YES, please describe the packaging and/or in-filler used:
6) Were you recommended to repack the parcel/document? ( Yes / No ) (Please circle one of them)
If YES, was the repackaging done in front of you? ( Yes / No ) (Please circle one of them)
7) Have you return the damaged (if lost, once recovered) parcel to J&T Malaysia? ( Yes / No ) (Please circle
one of them)
8) Here are the documents attached:
□ Photocopy of Claimant’s Identification Card (IC)
□ Details of the Claimant’s bank account
□ AWB Copy
□ Police Report ( If any )
□ Clear photographs of the external and internal packaging of the parcel. Eg: broken or tear.
□ Authorization letter (if Sender is a Corporation)
□ Genuine Receipt / Invoice of the claimed item (Purchase Invoice from Supplier)
□ Other Supporting Documents:-

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Claim Request Form Version 1.0

Condition Precedents of Making a Claim Request

1. The Claim Request Form shall only be completed by Sender/authorised person from Sender Company.
Any other parties except for the above mentioned shall not complete/assist to complete the Claim
Request Form. Otherwise, the Claim Request Form shall be null and void.
2. If the claimant is applying on behalf of company/Sender, a duly completed Authorisation Letter shall be
provided.
3. Submission of Duly completed Claim Request Form shall attached together with all the other documents
required as mentioned above. Should there be incomplete documents, the request will not be
entertained.
4. Duly completed Claim Request Form and all relevant documents shall be returned to the nearest drop
point of J&T Malaysia within 48 hours upon receipt of the parcel. Otherwise, any request for
compensation shall be invalidated.
5. Responsibility to prove the Loss (i.e damage/lost/others) shall lies solely on the Claimant.
6. Responsibility to adhere to Condition Precedents and fully comply with it shall lies solely on the Claimant.
7. Responsibility to provide the documents and ensure the accuracy of the information provided shall lies
solely on the Claimant.
8. Responsibility to return the damaged (or in the event of lost item recovered later) parcel(s) shall lies
solely on the Claimant.
9. Claimant shall bear all cost and expenses to return the damaged (or in the event of lost item recovered
later) parcel(s); J&T Malaysia will not provide any reimbursement whatsoever in this regards.
10. Responsibility to ensure the condition and/or quality of the returned good is no worse than it is (upon
receipt) shall lies solely on the Claimant.
11. Returned of damaged parcel(s) forms part of the claims request process. Notwithstanding to this, the
Claimant does not need to return the damaged parcel under any of the below circumstances, including
but not limited to, the following:-
A) Damaged parcels no longer hold any monetary values
B) Damaged parcels is considered total loss (e.g beyond repair)
12. J&T Malaysia shall be the rightful sole owner and have sole discretion of the damaged (or in the event of
lost item recovered later) parcel(s) upon completion of the Disbursement of Compensation.
13. Upon full investigation conducted by J&T Malaysia and in the event J&T Malaysia decides there should
be a compensation, the Disbursement of the compensation will be transferred to Claimant’s account
within 3 to 14 working days upon approval. Upon completion of the Disbursement, J&T Malaysia shall
not be party of any further negotiation/appeal/settlement/litigation process pertaining to the claim.
14. Upon full investigation conducted by J&T Malaysia and in the event J&T Malaysia decides there should
be rejection of the claim request, such decision is final. J&T Malaysia shall not be party of any further
negotiation/appeal/settlement/litigation process pertaining to the claim.
15. Claimant shall indemnify and hold harmless the J&T Malaysia from any and all claims, damages, fines,
judgments, penalties, costs, liabilities or losses arising out of or in any way related to claim in the future.
J&T Malaysia shall be absolved of all the above mentioned once a decision is made.

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Claim Request Form Version 1.0

Declaration of Claimant:
I understand my claim request is subject the terms and conditions of J&T Express (Malaysia) Sdn. Bhd
(hereinafter refer to as “J&T Malaysia”) and have taken full notice of the same.
I understand and agree that my claim is subject to the Condition Precedents mentioned above.
I understand that submission of this form is without prejudice to the terms and conditions of J&T Malaysia
and any breach of condition(s) the Claimant may have committed should not be regarded as a waiver by the
Company. I also understand that the acceptance of this form is NOT in itself an admission of Liability on the
part of J&T Malaysia.
I shall fully comply with the requirement(s) raised by J&T Malaysia and shall extend full co-operation to J&T
Malaysia as well. Should there be any action(s) from my end that would prejudice the position of J&T
Malaysia and/or the investigation of the claim, I accept that my claim request shall be rejected.
I accept that the compensation amount shall be determined by J&T Malaysia and J&T Malaysia shall have its
right to evaluate the compensation amount based on its market value as well as taking into consideration
including, but not limited to, the parcel(s) age, terms of usage (wear and tear), quality prior to claim
notification, advancement of technology and/or depreciation of value attached. The determination of
percentage of deduction in the final compensation amount, if any, shall be in J&T Malaysia sole discretion.
I accept any decision, upon investigation by J&T Malaysia, is final and shall be binding on all parties.
I hereby declare that the information provided by me on the above form is true and correct to the best of
my knowledge and belief. I also confirm that in the event of any information provided by me is not true and
incomplete, J&T Malaysia shall within its right to forfeit any compensation requested.
I hereby declare that any of my personal information collected or held by you herein is provided with my
consent for it to be used, processed and disclosed to individuals or organizations related to or associated
with J&T Malaysia (in and outside of Malaysia) including inter-departments within J&T Malaysia or any
selected third party service providers such as any service provider appointed by any corporate entities or
governmental and judicial bodies or regulators to whom J&T Malaysia is obliged to disclose under the
requirement of any law relating to J&T Malaysia or any of its affiliates or partners.
I agree to the limit of compensation outlined in the terms and conditions of J&T Malaysia. Should a decision
from J&T Malaysia result in compensation, it is on a without admission of liability basis. I agree and accept
the compensation amount to be transfer to my bank account as per following details :

Bank Name

Account No.

Account Holder’s Name

Declared and Acknowledged by : (for company use ONLY)

( Claimant/Authorised Personnel Signature ) Company Stamp

Name : Position :
IC No : Date :

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