Marine Cargo Insurance
Proof of Loss Declaration

Policy Number: Insured Name: Address: Contact Details:

Consignment Details

Consignment Description
Bill of Lading / Airway Bill No.
Vessel / Flight / Transport Name
Date of Arrival
Port of Loading
Port of Discharge
Final Destination

Details of Loss or Damage

Date and Time of Loss
Place of Loss
Circumstances of Loss
Estimated Amount Claimed
Particulars of Damaged Goods

Supporting Documents

Declaration

I/we hereby declare that the foregoing statements are true and correct to the best of my/our knowledge and belief, and that the amounts claimed represent the actual loss sustained.