Darlow Marine Insurance - Single Cargo APP
Please do not leave any form field blank. Use"unknown", "TBA", "TBD" or "n/a" where applicable.
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Applicant's name: *
Beneficiary (THIS IS THE NAME THAT WILL APPEAR ON THE POLICY AS "INSURED")
Full Address *
e.g. 9420 SW 77th Ave. #200 Miami, FL 33156 Unites States
Type of shipment *
If breakbulk, On deck or Under deck? *
Vessel name, Freight line, Airline or Flight # *
Conveyance: *
e.g. Air, Ocean or Inland transit
Port of loading: *
City/Town *
City/Town of loading
Country *
Country of loading
Port of discharge: *
City/Town *
City/Town of discharge
Country *
Country of discharge
Commodity *
Type of cargo
Condition of cargo *
Description of Cargo: *
Packing *
Required
Packing details:
e.g. Containerized, Saran Wrapped, Palletized, Boxed, etc...
Sailing on or about: *
Estimated date
MM
/
DD
/
YYYY
Total sum to be insured *
Total sum to be insured after factoring in all costs (Freight, Duty, 10% &/or Insurance)
Marks or Numbers *
Any special reference code or # you would like to appear on the policy, if & when bound (e.g. Bill of Lading #, Invoice #, etc...)
Notes *
Additional comments
Sign *
Print name
Email: *
*Email address where quotation is to be sent to
Who do we make the invoice out to? *
Name and address of the person or company to be invoiced.
Submit
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