Particulars of Insured
Name:
Address:
Postal Code:
Contact No:
Company's Name:
Commodity: (Description of Goods)
Packing: (pls tick as necessary)
By Container Vessels
By Conventional Vessel Shipped underdecked/on decked
*please delete where applicable
Sum Insured:
Voyage:
Vessel's Name/Flight No/Lorry No:
Estimated Date of Departure:
Coverage: (pls tick as necessary)
ICC A War Risk
ICC B SRCC
ICC C
Others:
Claims Experience for the last 3 years:
Yes No
Average Shipment Value:
Maximum Shipment Value:
Annual Turnover:
Remarks:
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