about us products our mission claims contact us

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
Personal
 Corporate
International Health Plans


Applicant Information Sheet for General Cargo
Insured's Name:
Address:
City:        State:        Zip:
Country:
Phone:        Fax:  
Email:

Estimated annual values of shipments to be insured in US Dollars:
    Current Year:
    Last Year:

Premium/Loss history for last three years in US Dollars:
YEAR GROSS PREMIUM PAID LOSSES OUTSTANDING LOSSES

Most Frequent Destinations:
    From:
   To:

Annual Percentage (%) Breakdown of Shipments:
    Approved General Merchandise and/or General Cargo:
    Electronic Precision Instruments, Consumer
    Electronics and Machinery which is prone to Breakage
    (Encluding Mobile, Cellular Telephones):
    Computers and Computer Related Equipment:
    Fragile Goods:
    Bottled Products, Excluding Beverages:
    Food Items and Pharmaceutical Products in Tins,
    Cans, Paper, Sachets, Liquid Items in Tins:
    Bottled Beverages (Liquors included):
    New Automobiles, Buses and Motorbikes:
    Used Automobiles, Buses and Motorbikes:
    Household Goods and Personal Effects:
    Frozen Food other than Frozen Meat:
    Frozen Meat:
    Chemicals:
    Steel Sheets, Coils, Bars, Billets and the like:

Average value of
any one shipmnent
Percentage of mode
of shipment
By Sea
By Air
By Land

Anyone unnamed location within the normal course of transit:
Name of your current insurance broker:
Are you satisfied with their claims handling: Yes    No
Are you satisfied with their rates: Yes    No
Expiration date of current policy:
Any remarks that you would like to share with us?

       




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