Proposal/Application Form

Parcel Guard
Product
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Agent code
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Payment Mode*
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Amount Insured
₦
Amount Payable
₦
DETAILS OF THE INSURED (PROPOSER/SENDER/OWNER OF THE GOODS TO BE TRANSPORTED)
Surname*
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Other Names*
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Gender
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Address*
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Phone Number*
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Occupation*
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Email Address*
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DETAIL OF GOODS/PARCELS TO BE INSURED
NOTE: Gas cylinders, Chemicals, Explosive materials, Ceramic tiles, Glass ware, Letters, Cheques, Bank drafts, stamps, jewelry, art work and Perishable goods are NOT covered under this Policy
Description of the Goods (Include Serial Nos. where applicable)
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Description of the Packaging
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Quantity (No of packages)*
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Cost per unit (or per package)*
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Total Value (in naira)*
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TRANSIT INFORMATION
Goods/Package will move from:*
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Goods/Package will move to:*
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Name of the reciever*
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Address of the reciever*
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Phone No of the reciever*
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Date of commencement of transit*
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Expected date of arrival/delivery*
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TRANSPORTER/COURIER/VEHICLE INFORMATION
How long will goods/parcels be conveyed*
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Mode of Shipment
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IF THE GOODS WILL BE TRANSPORTED BY A PRIVATE COMMERCIAL DRIVER, PLEASE STATE:
Driver's Name
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Driver's Phone Number
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Vehicle registration number
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By submitting this form you agree that the above details provided are true and complete and the insurance company issues a Policy in its usual terms and conditions.

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