Import/Export Marine Cargo Claim Form
Insured Details
Name of Insured
Policy Number
Address
Contact Number
Email
Cargo Details
Description of Cargo
Quantity
Invoice Value
Packing
Shipment Details
Shipper
Consignee
Vessel/Flight/Vehicle Name
Voyage/Flight Number
Bill of Lading / AWB Number
Date of Shipment
Port of Loading
Port of Discharge
Loss/Damage Details
Date of Loss/Damage
Time
Nature of Loss/Damage
Extent of Loss/Damage
Location/Place of Loss/Damage
Description of Incident
Surveyor/Authority Intimation
Surveyor/Authority Informed
Yes
No
Date Informed
Name of Surveyor/Authority
Documents Attached
Declaration
I/We hereby declare that the above statements are true and correct to the best of my/our knowledge and belief.
Place
Date
Name & Signature of the Insured