Single Shipment Cargo Form

*
- Quote Only
- Issue Certificate
Please enter your email address below. If you have previously used this cargo form, your information will be pre-filled.
Email*
Company Name*
Phone
Fax
Date of Departure*
Date Format: MM slash DD slash YYYY
Description of Goods*
Condition of Goods*
Insured Value: (should be CIF +10%)*
Packing Details*
Origin/From*
Destination/To*
Method of Shipment*
- Ocean
- Air
- Domestic Transit
Vessel Name*
Voyage No*
Name of Airline*
Airway Bill No.*
Trucking Co.*
Reference No.*
Letter of Credit?*
Marks & Numbers*
Loss Payee*
Terms*
- This form is for quoting purposes only. It is not a policy/contract. It does not modify, supercede nor change the policy in any way. This request for a quote or to issue certificate does not guarantee coverage is being afforded. Coverage is only provided when certificate is issued and premium is paid. Certificates are issued subject to all terms, limitations, deductibles and conditions of the Master Policy. All claims are subject to the terms and conditions of the Master Policy on the date the certificate is issued. For complete policy information refer to the policy document (available upon request). Receipt of the quote form via fax or email to our office does not guarantee coverage. In the event International Insurance Center has to engage an attorney or take collection action to collect any unpaid balance, the insured agrees to pay any and all reasonable and necessary collection costs as allowed by State Law.
Click here to see terms
This form is for quoting purposes only. It is not a policy/contract. It does not modify, supercede nor change the policy in any way. This request for a quote or to issue certificate does not guarantee coverage is being afforded. Coverage is only provided when certificate is issued and premium is paid. Certificates are issued subject to all terms, limitations, deductibles and conditions of the Master Policy. All claims are subject to the terms and conditions of the Master Policy on the date the certificate is issued. For complete policy information refer to the policy document (available upon request). Receipt of the quote form via fax or email to our office does not guarantee coverage. In the event International Insurance Center has to engage an attorney or take collection action to collect any unpaid balance, the insured agrees to pay any and all reasonable and necessary collection costs as allowed by State Law.

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