Marine Cargo Insurance Claim Form
Insured Details
Name of Insured
Policy Number
Address
Contact Number
Email
Shipment Details
Consignee
Voyage/Transit From
To
Invoice Number
Date of Dispatch
Carrier Name
Vessel/Flight Number
Bill of Lading / AWB No.
Date of Arrival
Loss / Damage Details
Date of Loss/Damage
Place of Loss/Damage
Description of Loss/Damage
Estimated Amount of Loss
Nature of Loss/Damage
Additional Information
Have Police/Authorities Been Notified?
Surveyor/Appraiser Name
Remarks
Declaration
Name
Signature
Date