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Credit Insurance
Quote Request
Household Goods and Personal Effects Insurance
Quote Request
Claim Form
Valued Inventory Form
Terms and Conditions
General Cargo Insurance
Quote Request
Claim Procedure
Terms and Conditions
Kidnap and Ransom Insurance
International Health Plans

Account Information Form

Insured's Name:
Nature of cargo to be shipped:
Percentage by Air:
Percentage by Sea:
Any portion of shipment new or used:
Who is the merchandise packed by?: Manufacturer   You

Insuring conditions:
Total loss only:     All Risk:
Wharehouse to Wharehouse:     Wharehouse to port
Limit per vessel:      250,000   500,000   1,000,000
Limit per container: 250,000   500,000   1,000,000

Port of entry:
Final destination:
Name & address of freight forwarders used:
Requested effective date of open cover:
Previous losses: Yes   No
Estimated annual value to be insured:
Estimated # of shipments & frecuency to be insured:
Annual premiums paid per year in the last 3 years:
Choice of deductibles (per shipment): 250   500   1000   5000


Mailing Address: P.O. Box 284, 15476 NW 76 Ct - Miami Lakes, FL 33016
Tel: (305) 556-1488  Fax: (305) 556-3680