All Risks Insurance Questionaire

NOTE: Fields marked with * are mandatory.
INSURED DETAILS:
* Individual / Company Name:
Address Details
* Street:
* Town:
* Postcode:
* P.O. Box:
* Country:
* Phone:
* Fax:
* Email:
* Internet Address:
Contact Person   Finance Contact Person
* Surname:   Surname:
* First Name:   First Name:
* Phone:   Phone:
* Fax:   Fax:
* Email:   Email:
        Vat No.
(SA Companies):
CARGO / COMMODITY DETAILS:
Commodity:
Are Goods New or Used:
New
Routing:
From:   To:
Load Value:
Currency:   Value:
Loading Date:

Off-Loading Date:
HAULIER:
Transport Company:
(If different to the details above):
Contact Person:
Contact Number:
Email Address:
Load Number:   For Office Use Only
Ref/Waybill Number:
Conveyance:
Road
Type of packaging:




  
Quantity:
How are goods packed?:
(Professionally / Not Professionally)