Proposal Form - Marine Cargo Insurance
ADVERTISEMENT
1P
F
– M
C
I
ROPOSAL
ORM
ARINE
ARGO
NSURANCE
To: Risk Management Insurance Brokerage Ltd.
Tel: 2529-7866
Fax: 2527-7511
Attn:
Date :
Company:
Tel:
Contact:
Fax:
Dear Sir / Madam,
I/We hereby authorize you to arrange the marine insurance coverage for the following shipment:
Assured
投保人:
Held to the order of
受權於(銀行名稱):
Amount Insured (Please indicate currency)
投保金額(註明貨幣):
Invoice value + 10% =
FOB + 10% =
CIF + 10% =
Other
Please fill in this form in English block letters and tick in the box where appropriate
Transportation
Departure date
dd
mm
yyyy
From
To
Via
By Sea
Vessel name
Bill of lading no.
MAWB no.
By Air
Flight no.
HAWB no.
By Land
Type of vehicle
Lorry
Van
Container tractor
Vehicle no.
Enclosed metal truck
Train
Wagon no.
By Post
Type of post
Surface parcel
Speed parcel
Courier
Postal receipt no.
Air parcel
Insured parcel
If goods are shipped in container, please indicate
LCL
FCL
Description of Goods, Kind of Package
Marks & Numbers
Please use and attach a separate piece of paper if there is insufficient space below
Insurance Cover
Institute Cargo Clauses (A)
Institute War Clauses (Cargo)
Institute War Clauses (Air Cargo) (
excluding sendings by Post)
Institute Cargo Clauses (B)
Institute Strikes Clauses (Cargo)
Institute Strikes Clauses (Air Cargo)
Institute Cargo Clauses (C)
Institute Cargo Clauses (Air)
Institute Theft, Pilferage & Non-delivery Clause
(excluding sendings by Post)
Institute Replacement Clause
Other Remarks
(dd/mm/yyyy)
Proposer's Signature with Company Chop if applicable
Date
1.
This application form is not binding unless replaced by a formal insurance certificate. The application form would then become
part of the insurance policy and the coverage is subject to applicable insurance clauses.
2.
The Assured has to submit document proving the insurable interests / title of claim in case of claim.
RMIB-MCI-0305
ADVERTISEMENT
0 votes
Related Articles
Related forms
Insurance Tax Return Form - Property Casualty Insurer - Distirct Of Columbia Department Of Insurance,securities And Banking - 2011
Legal
Form 48495md4 - Life And Disability Income Insurance Enrollment Form - Reliastar Life Insurance Company
Legal
Form Il446-0152b - Insurance Producer/registered Firm Bond Form - Illinois Department Of Insurance
Legal
Form Ig255 - Nonadmitted Insurance Premium Tax Return For Direct Procured Insurance - 2012
Financial
Form 74a117 - Monthly Insurance Surcharge Report Domestic Mutual, Cooperative And Assessment Fire Insurer
Financial
Related Categories
Parent category: Business