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- Click ‘Get Form’ to open it in the editor.
- Begin with Part I - Certification. Fill in blocks 1-5 with the stock number, description, and quantity of the item(s) lost or damaged. Check the appropriate box indicating whether the item was lost or damaged.
- In block 5, indicate if the damage was due to negligence by checking 'Yes' or 'No'. Provide a detailed description of the circumstances surrounding the loss or damage in the designated area.
- Proceed to block 7a and sign your name, followed by entering the date in block 7b.
- Move to Part II - Action. Review the evidence and indicate your agreement or disagreement regarding negligence in block 8. Select all applicable actions from block 9 through block 12 based on your assessment.
- Finally, sign and date in blocks 13a, 13b (title), and 13c respectively to complete the form.
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| Versions | Form popularity | Fillable & printable |
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| 1989 | 4.9 Satisfied (207 Votes) |
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