Cargo Insurance for Business Goods: Quotation Form


Required Fields are marked with a *

  
Your Name:*
Your Address:
Postcode:
Telephone:
Fax: 
What is your contact e-mail address?*
Year Established
Where did you hear about us?
Freight Forwarder being used:

 
Description of Goods being sent*
Are the goods New or Used?*
Weight of Goods: kgs
Where From?*
Where to?*
Via?
How are the goods packed?
Who is packing the goods?
Mode of transport*
Load Size*


Value of goods* £
Cost of Transportation £
Is the sending subject to a Letter of Credit?  
Are these goods sent  
           
Has any claim been made on any previous Marine Cargo Insurance Policies?*
If yes, please give details:  
Date
Brief details of each claim
Cost of claim
Estimated Outstanding
 
I/We hereby declare that the above statement and particulars are true and that I/we have not suppressed or mis-stated any material facts and I/we agree that this Declaration shall be the basis of the Contract between me/us and the Underwriters.

COMPLETING THIS FORM DOES NOT BIND THE PROPOSER TO COMPLETE THE INSURANCE