QUESTIONNAIRE FOR THE SETTLEMENT OF MARINE INSURANCE (Open cover)

Use the Following Form to Place an Order

 
(a)
GOODS to be insured :  DESCRIPTION of packing material:          
I.;    
II.;   
II.;    
IV.;   
V.  ;   
VI. ;   
(b)
Describe and fill in  
Imports ore exports:  from:  to:                             Turnover p.a. USD : 
 I.   
II. 
II.  
IV.  
V.    
VI.  
Delivery Information:

       Name: 
    Company: 
  Address 1: 
  Address 2: 
       City:  State: 
   Zip Code:  Country: 

Voice Phone: 
        Fax: 
      Email: