MARINE CARGO DEPT.
 
 
Date:
Name of Proposer:
Address:
Under Open Policy/ Cover no.:  
Current Address:    
Contact Phone  
Email Address  
Address  
 
DECLARATION UNDER MARINE POLICY/CERT. OF INSURANCE
 
Please issue Marine/ Transit Policy/ Certificate of Insurance in duplicate/ triplicate for following goods.
Assured
shipped/ despatched per
under B.L/R.R./AWB/CN.No.
date
From:
To:
Claims payable at
in (Currency)
     
Marks & No.
Nature of Packing
Description of Goods
Sum Insured Rs.
Terms of Cover
Place:
Date:
 
 
 
 
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