Proposal/Application Form

Parcel Guard
Product
Agent code
Amount Insured
Amount Payable
DETAILS OF THE INSURED (PROPOSER/SENDER/OWNER OF THE GOODS TO BE TRANSPORTED)
Title
Surname*
Other Names*
Gender Address*
Phone Number*
Occupation*
Email Address*
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)
Description of the Packaging
Quantity (No of packages)*
Cost per unit (or per package)*
Total Value (in naira)*
TRANSIT INFORMATION
Goods/Package will move from:*
Goods/Package will move to:*
Name of the reciever*
Address of the reciever*
Phone No of the reciever*
Date of commencement of transit*
Expected date of arrival/delivery*
TRANSPORTER/COURIER/VEHICLE INFORMATION
How long will goods/parcels be conveyed*
Mode of Shipment
IF THE GOODS WILL BE TRANSPORTED BY A PRIVATE COMMERCIAL DRIVER, PLEASE STATE:
Driver's Name
Driver's Phone Number
Vehicle registration number