ARGUS COSMETICS LIMITED

DAMAGE CLAIM FORM

NAME OF STOCKIST: Brahmadeva Enterprises DATE OF CLAIM:

TOWN NAME: Turuvekere STATE: karnataka

TRANSIT DAMAGES
DETAILS OF TOTAL NUMBER OF DAMAGED STOCKS BEING CLAIMED

Z Classic Talc Z Classic Deo Z Classic Soap Z Icon Talc Z Icon Deo Total value
S.No Paticulars
20g
50g 100g 200g 20ml 45ml 75ml 150ml 30g 75g 3+1 125g 50g 100g 200g 60ml 120ml 180ml
1 Quantity Damaged ( nos ) 3 7 3 8 10 1 25 5
2 Rate / Piece (Rs.Ps) 110 190 70 105 12 27 60 155
3 Claim Value (1*2) 290 1220 210 861 120 27 750 387 3865
4 Total Claim value =………………………………..
5 Name of Consignor
6 Invoice No & Date
7 Transpoter name
8 Lorry Receipt No
9 Date of Receipt of goods

Note:1 Details of each of the damaged tins to be forwarded to SR alongwith this claim

2 Goods Damaged in transist to bepacked well and returned to the consignor Depot / C & FA
through reliable transport within 45 days of receipt of goods with a copy of claim form.

3 Copy of the Lorry Receipt as mentioned in 2 and the Damaged tins details covering each

claim to be collected by SR from stockist and sent to HO alongwith this claim form Stockist Signature with Rubber Stamp

To be filled in by SR / SO

I hereby certify that the damaged goods as detailed above have been
returned to ……………………… on ……………………..( date ) Vide L.R.No……………………………………………………...of………………………………………..Transport

I recommend issue of Credit note for Claim Amount

Abhilash
RSM / ASM Signature & Name Signature of SR / SO with name

To be filled in by H.O Claim Received on: LR Available?Yes/No;Details recd?Yes/N

Goods Received Note No for damged Stocks: Inspection Report recd.? Yes/ No
Quantities & Amount allowable for claim:

Remarks: Prepared by Verified by Approved by

Abhilash
 ARGUS COSMETICS LIMITED
DETAILS OF DAMAGED GOODS
NAME OF THE Rds/ SAnniveerabhadreshwar agency DATE OF CLAIM:
TOWN NAME: Haveri STATE: karnataka

Product Name Pack Size Batch No Pkd Manufactured by Nature of Damage MRP Quantity Value

Talc 100g A 338 Expired 99 15

Talc 100g B 1978 expired 99 4
talc 100g a 1978 expired 93 5
talc 100g A 128 expired 120 2

after shev expired 230 2

talc 50g a 250 expired 55 6

talc 50g a 1386 expired 60 1

talc 50g b 623 expired 50 2

talc 200g a 729 expired 150 2

talc 25g a 225 expired 15 6

deo 45ml b 006L expired 82 1

deo 75ml b 014L expired 126 2

soap set expired 90 2

TOTAL