To,

Station............... the

Dear sir,

Re: GR No…….. Dated………..

Consignor....................... ...............

ex......................... to........ ……….

Contents.......................... ……………

I........................ ...S/o Mr.....................

..................................... Of (address)...........

Prorietor/Partner/Director/Manager of

M/s.......................................................................

Do hereby declare that we are actual consignee and the present owner of the goods covered by the above consignment note has been lost/misplaced from our possession.

Therefore, we shall be highly obliged if you kindly deliver us the consignment. Needless to mention here that I and our above firm individually and/or jointly will remain liable for all losses, damages, disputes etc., arising out of this and these will be settled within three days of receipt of such intimation from you/your agents/consignors or their authorized agents and their decisions will be binding on us.

Yours faithfully,

Sd/-

(Rubber Stamp & Signature)