Proposal/Application Form

Marine Cargo Insurance
Product
Agent code
Variant (Cover type)*
Amount Insured
Amount Payable
THE PROPOSER/APPLICANT
Name of Insured*
Customer type
Date of Incorporation or Registration *
Incorporation/Registration Number *
Gender Date of birth *
Contact Address *
Occupation/Nature of Business *
Phone Number*
Tax Identification No. (TIN)
Bank Interest/Value
Email Address*
OTHER DETAILS
Entry Date [This is current Date of issuance]
Commencement Date [Start date and End date is the date the insurance cover will commence. Both dates are only future dates.]
Expiry Date [End date is not necessarily 365 days from start date]
Cover Type Conveyance (Mode of Transit) Packaging Type (Mode of Transit) Proforma Invoice Number
Upload Invoice*
Description of Consignment (Subject matter/Interest)
Voyage From
Voyage To