FMC-33 Dispute Resolution Services Request-Cruise

FMC Form-33 (8/2019)

OMB Control No. 3072-0072

Federal Maritime Commission

Dispute Resolution Services Request -Cargo
Person Requesting Assistance

Return to CADRS@fmc.gov

Name:
Business Name:
VOCC

Type of business (check one):

NVOCC

))

MTO

Importer

Exporter

Customs Broker

Other

Current Address:
City:

State/Province:

ZIP/Postal Code:

Preferred Phone Number (9AM-5PM EST):

E-Mail:

Name of attorney (if any):

Attorney’s phone number:

Country:

Attorney’s email address (if any):

Dispute is With
Business Name:
Address:
Type of business (check one):

VOCC

NVOCC

MTO

))

Importer

Exporter

City:

State/Province:

ZIP/Postal Code:

Phone:

E-Mail:

Fax:

Customs Broker

Other

Country:

Have you contacted anyone at this company about your complaint?
If so, please indicate who:

What is the best way to contact:

Nature of Dispute
Type of Shipment (check one):

Household Goods

Commercial Cargo

Import to U.S.?
This dispute is related to (check one):

Export from U.S.?
Freight rate
Loss/damage

Demurrage/Detention/Per diem
Other

Non-Delivery

If other, please explain:
Date of transaction:
Amount in controversy: $
Desired solution:
How did you hear about FMC/CADRS?

P l e a s e e x p l a i n y o u r d i s p u t e a n d a t t a c h a l l r e l e v a n t d o c u m e n t s ( e .g .: B i l l s o f L a d i n g , S h i p p i n g
Contracts, B ook ing Confirm ations, Correspondence, etc… )

Affirmation: I understand that the information that I have provided is for the purpose of convening the use of confidential dispute
resolution services to resolve a cruise related dispute. As such, I authorize CADRS to contact the named party(ies) to engage in
efforts to seek resolution to this matter. Also, in the event that this matter falls outside of FMC jurisdiction, I authorize CADRS to
refer my request for assistance to the appropriate governmental agency possessing jurisdiction over my complaint. Unless otherwise
marked confidential in this intake form or attached documents, I authorize CADRS to disclose information provided in the intake form
to the other named party(ies) for the purpose of exploring resolution to this dispute. I understand and agree that CADRS staff will act
as a neutral third party in this matter and as such CADRS’ staff cannot provide me with legal representation or advice. I also
understand and agree that participation is voluntary and that any party and/or CADRS staff may decline or terminate this process at
any time. I affirm that the information provided in this intake form, to the best of my knowledge, is true and accurate. If false
statements or documentation are provided, the matter will be closed.
Signature:

Date:

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid
OMB Control Number. The OMB Control Number for this information collection is 3072-0072. Public reporting for this collection of information is
estimated to be approximately 10 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and
reviewing the collection of information. All responses to this collection of information are voluntary, and will be provided confidentiality to the extent
allowed by the Freedom of Information Act (FOIA) and the Alternative Dispute Resolution Act (ADRA). Send comments regarding the burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal
Maritime Commission, 800 N. Capitol Street, NW, Washington, DC 20573.