Claim Release and Receipt

Ref.: Name of Vessel-Voy.;

Description of cargo;

Master B/L number; LCL B/L number;

POL-POD

Alleged [describe type of damage/loss].

In consideration of the sum of [Insert settlement amount], receipt of which is hereby acknowledged, we, the undersigned, hereby release and forever discharge LauritzenCool Logistics AB, its successors, servants, agents, insurers and/or underwriters from any and all liability for the above mentioned damage/loss.

Yours faithfully,

Date: [Insert date]

____________________ [Signature]

[Claimant’s name]