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Loss/Damage Report

PROVINCE: COMMODITY;
DISTRICT: SHIPMENT NO: PROJECT NO:

LOCATION:

1 DETAIL TIME, PLACE AND TYPE OF LOSS OR DAMAGE:


2 DESCRIBE AMOUNT LOSS BELOW:

DESCRIPTION Number oF Units Net Kga. Each TOTAL

1. Units Damaged ( Potential Loss)

2. Qunatity Recovered

3. Loss By Damage

4. Missing Entirely

TOTAL LOST

3 Nature and extent of loss, Damage or Misuse

4 Who were the person or the agency having possession at the time of loss or damage

5 Details the circumstance under which the loss or damage took place

6 Current location or disposition of commodities

7 What action have been taken to effect recovery?

8 What action have been taken to preclude further losses?

9 Other Comment:

Prepared By: Date:

Checked By: Date:

Approved By: Date:

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