| Insurance Application-Instructions | UVW EXPORTS
88 Prosperity Street East, Suite 707
Export-City and Postal Code, Export-Country
Tel: (07) 1234-5678 Fax: (07) 1234-8888
E-mail: shipping@uvwexports.com.jp |
Shipper's
Reference | Sales Confirmation No. | Commercial Invoice No. | Insurance
Company | Name | Tel. No. | Fax. No. | Contact Person | Ref. No. |
|
| | | | |
| 1. | NAME OF THE ASSURED (Beneficiary - Payable to the order of): |
| 2. | AMOUNT INSURED: |
| 3. | TERMS OF INSURANCE COVERAGE (Clauses): |
| 4. | LATEST ISSUING DATE OF INSURANCE POLICY: |
| Loading On Board date: |
| Dispatch/Taking In Charge date:
|
| 5. | CLAIM AGENT: |
| Indicate complete name and address of claim agent at port of destination. |
| Indicate claims payable in __________________________ (city, country)
in ____________________ currency.
|
| 6. | DESCRIPTION OF PACKAGES & GOODS: |
| 7. | MARKS & NUMBERS: |
| 8. | CONTAINER NUMBER: |
| 9. | CARRIER - VOYAGE/FLIGHT NO. |
|
| 10. | SHIPMENT ON OR ABOUT |
|
| 11. | FROM (Port of Loading) |
|
| 12. | FROM (Place of Dispatch/Taking In Charge) |
|
| 13. | TO (Port of Discharge) |
|
| 14. | VIA (Tranship At) |
|
| 15. | THENCE TO (For Transhipment To) |
|
Other Instructions | Insurance Rate | No. of copy of the
Insurance Policy required | Original | Premium | Copy (Duplicate) |
|
| Issued by: | Date: |
Relation Articles:
