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Marine Cargo – Individual Cover

Thank you for your response. ✨

INSURED NAME(required)

CONTACT PERSON(required)

MOBILE NUMBER(required)

EMAIL ID(required)

COMPLETE ADDRESS (required)

DESCRIPTION OF GOODS(required)

BRAND NEW SECOND HAND FRAGILE OTHER

IF OTHERS, PLEASE CLARIFY(required)

DESCRIPTION OF PACKING(required)

CONTAINERIZED NON-CONTAINERIZED

TYPE OF CONVEYANCE(required)

BY VESSEL BY AIR BY LAND

DETAILS OF VESSEL OR AIR CONVEYANCE

IF TRANSPORTED BY LAND, PLEASE PROVIDE NAME OF TRANSPORTER

ADDRESS OF TRANSPORTER

TELEPHONE NUMBER OF TRANSPORTER

DOES THE TRANSPORTER HAVE HAULIER’S LIABILITY INSURANCE POLICY?

YES NO

IF YES, PLEASE PROVIDE HAULIER’S LIABILITY INSURER AND POLICY NUMBER

DATE OF VOYAGE (FROM)(required)

YYYY-MM-DD

DATE OF ARRIVAL (TO)(required)

YYYY-MM-DD

SAILING DATE

YYYY-MM-DD

SUM INSURED(required)

BASIS OF VALUATION(required)

CIF + 10% C&F + 10% FOB + 20% EX-WORKS + 20% OTHERS

IF OTHERS, PLEASE SPECIFY

COVER OR RISKS TO BE INSURED AGAINST(required)

ICC (A) + War & SRCC (Sea) ICC (C) + War & SRCC (Sea) ICC (C)+ND War & SRCC (Sea) Total Loss Only (Sea) ICC (AIR)+War & SRCC Airfreight (Ordinary) Only All Risks Land Transit + War on land Land Transit Clause (Ordinary) Only

PLEASE PROVIDE CLIENT LOSS RECORD FOR THE PAST 3-5 YEARS(required)

OTHER DETAILS

We hereby declare that the statements made by us in this online questionnaire are, to the best of our knowledge and belief, complete and true and we hereby agree that this online questionnaire forms the basis and is part of any policy issued in connection with the above proposed risks. (required)

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