Cargo Insurance

Insurance Request

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*First name:

*Last name:

*Company name:

*Email:

*Phone number:

*Assured: (as it will appear on policy)

*Description of cargo

Select what is applicable:

New

Used

Dry

Refrigerated

Containerized

Perishable

Seasonal

Single Shipment

Open Cargo Policy

*Total invoice value (US$):

Total freight charges (US$):

Shipment date:

* Which method of transportation are you using?

Ocean

Air

Inland

Origin:

*Port of Loading:

Final destination:

*Port of Discharge:

Carrier:

Booking or Bill of Lading #:

Marks & numbers:

Reference #:

Any portion of trip done by rail?

Yes

I don't know

* Type of Shipment:

Full Container Load

Less Than Container Load

Non-Containerized

* Airport of Origin:

*Airport of Discharge:

*Carrier:

*Piece count:

*Type of packaging:

Box

Crate

Pallet

Other

Booking or Bill of Lading #:

Dimensions:

Weight (lbs):

Additional comments:

*Origin address:

*Destination address:

*Carrier:

Motor Carrier #:

Your reference #:

*Estimated transit time:

Same day delivery

Other:

Number of transfers?

Is it an exclusive load?

Yes

*Piece count:

*Type of packaging:

Box

Crate

Pallet

Other:

Dimensions:

Weight (lbs):

Additional comments:

Do you currently have a cargo insurance policy?

Yes

Estimated number of monthly shipments:

*Estimated annual insured values:

*Maximum value per shipment:

*Origins:

*Destinations:

*3 Year Claim History:
(# of claims and $ paid)

Additional Comments:

Disclaimer

Coverage is not bound by submitting this form. This information is required for an underwriting evaluation from Seven Seas. The statements by the applicant are warranted to be true and are considered official material to the application. Any resulting insurance proposal will be based on the information provided.

(800) 471-7SEA