Date of Irregularity :                                                                                       

MAWB/HAWB No.  :                                                                                      

Flight Date             :                                                                                      

Shipper/Consignee :                                                                                       

Nature of Irregularity :     □    Written                □    Verbal                              

Description of complaint:                                                                                 

Corrective Action Recommended :                                                                   

                                                
 Section/Dept Head (Name/Sign)