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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
Used
Routing:
From:
To:
Load Value:
Currency:
ZAR
USD
EUR
GBP
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
Air
Sea
Rail
Type of packaging:
Sea Container – LCL
Sea Container – FCL
Boxes
Crates
Pallets
Other – Please specify:
Quantity:
How are goods packed?:
(Professionally / Not Professionally)
Get in Touch
Telephone
021-930 9166