Marine Insurance Proposal Form

Please fill this form, and click submit at the end, we will respond very soon:

  1. Please provide the following contact information:

    Organization
    Street Address
    Address (cont.)
    City
    State/Province
    Zip/Postal Code
    Country
    Work Phone
    FAX
    E-mail

  2. Description of goods


  3. Name of Bank.


  4. L/C Number


  5. Amount of Shipment


  6. Name of vessel.


  7. Voyage


  8. Sailing date


  9. Arrival date


  10. Specify type of packing

    Containers    Wooden Boxes  Cartons       Pallets     
Bulk

  11. Type of Cover

    Institute Cargo Clause (A)
    Institute Cargo Clause (C)

  12. Remarks


  13. Date of Proposal

    -- dd/mm/yy

Copyright © 2000 [Int'l Islamic Insurance Co.].
 All rights reserved.
Revised: February 25, 2001