Marine Cargo Insurance

Please be advised that FP Marine Risks is unable to provide a quote for household removal insurance. If you are looking for insurance to cover your move, we recommend that you talk to your freight forwarder who should be able to arrange this for you.

Name of Assured
Address
City	State/Province	Zip/Postal Code
Country
Contact Name	Phone Number
Email
Nature of Business

Description of Cargoes to be insured	Voyages	Anticipated Annual Value of Goods to be insured (please specify currency)	Packing	Mode of Transport

Are the Goods New or Used?	Duration of Coverage (e.g. Port-Port, Warehouse-Warehouse, etc.)
Basis of Valuation Required (e.g. CIF + 10%)	Mode of Transit

For Ocean Transits only:

Are the shipments in full container loads, door to door? Yes No		If no, please state whether they are LCL or Break Bulk: LCL Break Bulk

Do you grant any waivers of subrogation? Yes No		Is storage required beyond the normal course of transit? Yes No
If yes, to whom?

Estimated maximum value of cargo on any one vessel (please specify currency)	Estimated maximum value at risk at any one time in any one location (please specify currency)

Loss Experience for the last three (3) years (please send additional sheet if necessary)

Losses* Paid* Outstanding Deductible applied?

Yes  Amount

No

Yes  Amount

No

Yes  Amount

No

Yes  Amount

No

Yes  Amount

No

*Please specify currency here:

Losses*	Paid*	Outstanding	Deductible applied?
			Yes Amount	No
			Yes Amount	No
			Yes Amount	No
			Yes Amount	No
			Yes Amount	No