Marine Cargo Insurance Effective Date(Required) DD slash MM slash YYYY Expiry Date(Required) DD slash MM slash YYYY Policy NumberAgent(Required) Assured(Required) Email(Required) Address(Required)Invoice Amount(Required)Currency(Required) USD EURO POUNDS ZAR MWK Loading RateSum Insured(Required)Currency Conversion Rate(Required)Interest Covered(Required) Basis of Valuation(Required) Voyage details(Required) Date of Despatch(Required) DD slash MM slash YYYY Mode of Dispatch(Required)Mode of DispatchAirRoadSeaRailAir and RoadSea and RoadSea and RailMode of Dispatch(Required)Mode of DispatchMode of DispatchAirRoadSeaRailAir and RoadSea and RoadSea and RailMode of Dispatch(Required)Mode of DispatchAirRoadSeaRailAir and RoadSea and RoadSea and RailType of Cargo(Required) Dry Wet Explosives Vessel/Conveyance(Required) Container No & Other Information(Required) Conditions of Insurance Institute Cargo Clauses ( C) CL 384 of 1/1/09 Institute Strike clauses (Cargo) CL 256 of 1/1/82 Institute War Clause (Cargo) CL 255 of 1/1/82 Institute Cargo Clauses “A”(All Risks Institute Strikes Clauses (Cargo) Institute Classification Clauses Institute Location Clauses Institute War, Strikes Riot and Civil Commotion Policy Excess Policy Excess Dispatch Details Financial interest PremiumSurtax (16.5%)Stamp DutyTotal PremiumPremiumSurtax (16.5%)Stamp DutyTotal PremiumPremiumSurtax (16.5%)Stamp DutyTotal PremiumIssued by:(Required) Signature Marine Cargo Insurance Effective Date(Required) DD slash MM slash YYYY Expiry Date(Required) DD slash MM slash YYYY Policy NumberAgent(Required) Assured(Required) Email(Required) Address(Required)Invoice Amount(Required)Currency(Required) USD EURO POUNDS ZAR MWK Loading RateSum Insured(Required)Currency Conversion Rate(Required)Interest Covered(Required) Basis of Valuation(Required) Voyage details(Required) Date of Despatch(Required) DD slash MM slash YYYY Mode of Dispatch(Required)Mode of DispatchAirRoadSeaRailAir and RoadSea and RoadSea and RailMode of Dispatch(Required)Mode of DispatchMode of DispatchAirRoadSeaRailAir and RoadSea and RoadSea and RailMode of Dispatch(Required)Mode of DispatchAirRoadSeaRailAir and RoadSea and RoadSea and RailType of Cargo(Required) Dry Wet Explosives Vessel/Conveyance(Required) Container No & Other Information(Required) Conditions of Insurance Institute Cargo Clauses ( C) CL 384 of 1/1/09 Institute Strike clauses (Cargo) CL 256 of 1/1/82 Institute War Clause (Cargo) CL 255 of 1/1/82 Institute Cargo Clauses “A”(All Risks Institute Strikes Clauses (Cargo) Institute Classification Clauses Institute Location Clauses Institute War, Strikes Riot and Civil Commotion Policy Excess Policy Excess Dispatch Details Financial interest PremiumSurtax (16.5%)Stamp DutyTotal PremiumPremiumSurtax (16.5%)Stamp DutyTotal PremiumPremiumSurtax (16.5%)Stamp DutyTotal PremiumIssued by:(Required) Signature
