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Application for Ocean Cargo Insurance


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Contact Inforamtion
First Name
Required
Last Name
Required
Mailing Address
Required
ZIP / Postal Code
Required
Phone Number
Required
E-Mail Address
Required
Applicant Inforamtion
Applicants Name & Address
Required
Nature of Applicants Business
Required
Has applicant had previous insurance?
Required
If yes, please provide the following: Name of carrier, # of yrs with carrier, rates and terms with current carrier.
Optional
Reason for changing carriers?
Required
Does the applicant have any losses over the last five years?
Required
If yes, please describe
Optional
Insurance is required for (check all that apply)
Optional


Products / Packaging information
Are products being shipped
Required
How are individual items packed? (check all that apply)
Optional



If there is any special wrapping please describe
Optional
Are containers used?
Required
If yes, which of the following container types are used? (check all that apply)
Optional


Are items professionally packed?
Required
Do you use marks or advertising on cartons and/or cases?
Required
Any special agreement with carriers that limit liability?
Required
Cargo Section
Countries of origin and destination
Required
Value of insured shipments per annum
Required
Value by mode of transport? ( please specify Sea, Air, Other)
Required
Limit required (please specify by Sea, Air, Other)
Required
Maximum value per package
Required
Average value per shipment
Required
Aprox. what percentage of shipments require transhipment
Required
How do you value your cargo? (ex: invoice+freight)
Required
Do you wish to ensure duty and taxes?
Required
What is the average rate of duty paid on your imported cargo?
Required
What deductible are you requesting?
Optional



Supplementary Coverage
Other protection required
Optional



Pure domestic inland transit geographic limit?
Optional
What mode of transport is used for domestic inland transit?
Optional
Are trucks owned or leased?
Optional
Are common carriers employed?
Optional
Domestic transit protection desired
Optional
What deductible are you requesting?
Optional



Additional comments or questions
Optional
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.




 
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