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Insured Details Self

INSURED NAME *

ADDRESS *

STATE *

CITY *

PINCODE *

Billing Details Self

GST NO. *

BILLING NAME *

ADDRESS *

STATE *

CITY *

PINCODE *

Cargo Details

CARGO DESCRIPTION

COMMODITY

ODC CARGO

ORIGIN COUNTRY

TERMS OF SALE

TRANSIT MODE

PACKAGING

SUB-PACKAGING

COVERAGE FROM

COVERAGE TO

TRANSIT START DATE

BASIS OF VALUATION

COVERAGE

Additional Details

INVOICE NO.

INVOICE DATE

BL NO.

BL DATE

VESSEL NAME

VESSEL DETAILS

BUYER / CONSIGNEE

SELLER / CONSIGNOR

JOB NO.

ADDITIONAL INFO

Value Details

CURRENCY *

EXCHANGE RATE (INR) *

INVOICE AMOUNT (USD) *

EXTRA % *

FREIGHT (INR)

DUTY (INR)

SUM INSURED (INR) *

Attachment Details

BILL OF LADING *

COMMERCIAL INVOICE *

PACKING LIST *

ANY OTHER DOCUMENT

Insurance Premium

NET PREMIUM

GST

TOTAL PREMIUM (INR)

Cargo Details

CARGO DESCRIPTION

COMMODITY

ODC CARGO

DESTINATION COUNTRY

TERMS OF SALE

TRANSIT MODE

PACKAGING

SUB-PACKAGING

WAREHOUSE TO WAREHOUSE

COVERAGE FROM

COVERAGE TO

TRANSIT START DATE

BASIS OF VALUATION

COVERAGE

SETTLING AGENT

Cargo Details

CARGO DESCRIPTION

COMMODITY

TRANSIT MODE

PACKAGING

SUB-PACKAGING

COVERAGE FROM

COVERAGE TO

TRANSIT START DATE

COVERAGE

BASIS OF VALUATION

Note:Tail-end risk from import is covered under Import tab (port to buyer’s warehouse)

Value Details

INVOICE AMOUNT (USD) *

EXTRA % *

FREIGHT (INR)

SUM INSURED (INR) *

Movement Details

COMMODITY

TRANSIT MODE

TRANSIT TYPE

COVERAGE FROM

COVERAGE TO

TRANSIT START DATE

COVERAGE

BASIS OF VALUATION

Container Details

CONTAINER / BE NO. / BOOKING NO. *

CONTAINER SIZE *

CONTAINER VALUE (INR) *

SUM INSURED (INR) *

Additional Details

BUYER / CONSIGNEE

SELLER / CONSIGNOR

JOB NO.

ADDITIONAL INFO

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