Darlow Marine Insurance - Single Cargo APP
Please do not leave any form field blank. Use"unknown", "TBA", "TBD" or "n/a" where applicable.
Applicant's name:
Beneficiary (THIS IS THE NAME THAT WILL APPEAR ON THE POLICY AS "INSURED")
Your answer
Full Address
e.g. 9420 SW 77th Ave. #200 Miami, FL 33156 Unites States
Your answer
Type of shipment
If breakbulk, On deck or Under deck?
Vessel name, Freight line, Airline or Flight #
Your answer
Conveyance:
e.g. Air, Ocean or Inland transit
Port of loading:
Your answer
City/Town
City/Town of loading
Your answer
Country
Country of loading
Your answer
Port of discharge:
Your answer
City/Town
City/Town of discharge
Your answer
Country
Country of discharge
Your answer
Commodity
Type of cargo
Your answer
Condition of cargo
Description of Cargo:
Your answer
Packing
Required
Packing details:
e.g. Containerized, Saran Wrapped, Palletized, Boxed, etc...
Your answer
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)
Your answer
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...)
Your answer
Notes
Additional comments
Your answer
Sign
Print name
Your answer
Email:
*Email address where quotation is to be sent to
Your answer
Who do we make the invoice out to?
Name and address of the person or company to be invoiced.
Your answer
Submit
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