Land Transit Insurance Proposal Form
 
Please select the country/city where the form is to be submitted
1 Insured Name
2 Address
3 Telephone No
4 Fax No:
5 E-mail
Policy No.
Cert. No  
Open Policy No.
Declaration No.
Name Of The Bank P.O.Box No. Emirates L/C No.
Name Of Insured:
A/c
DESCRIPTION OF THE COMMODITY INSURED (Please Describe Fully)
Packing: Invoice / Order No. Valuation:
1.


2. FCL (Full Container Load).


3. LCL (Loose Container Load)


4.Others







Currency Amount(Invoice Value)
Amount Insured
Exchange Rate  Dhs
Premium%
Voyage From :
To     :
Via    :
Marine@
War @
   
Policy Fee
Total Premium
Mode of Convy.

Steamer

Airfreight

Parcel Post

Motor Truck

Launch/Country Craft
 Name of the Carrier

B/L or AWB No./Etc.
s.s/m.v  
Flt.No. 
Name    
veh.No.  

Name   		 
   

CONDITIONS
C095 - Sea Voyage
C001 - I.C.C. (A)
C003 - I. C.C.(C)
C006 - I.C.C. (C) + ND/Cont
C007-I.C.C.(C)+ND/Unit Pkg
C008 - War
C009 - SRCC
C012- I.C.C. (Air)
C013- War (Air Cargo)
C014- SRCC (Air Cargo)
C010- Inst. Classification
C011- R'active Cont. Excl.)
C025-Total Loss Only
C096 - Land Voyage
C016 - Land Transit
C017 - Land Transit (AR)
W032 - Bridges Warranty
C029 - Inst. Frozen Food (A) - Excl.Frzn.Meat
C030 - Inst.Frozen Food (C)-Excl.Frzn Meat
C032 - Inst. SRCC (Frozen Food)
C033 - Inst. Frozen Meat (A)
C034 - Inst. Frozen Meat(A) 24 hrs B'dwn
C035 - Inst. SRCC (Frozen Meat)
Excluding:
E001 - Rust/Odixation/Discolour
E002 - R.O.D sea water
E003 - Mech/Elect/Dreangement
E014 - Scratching/Chipping/Denting
E017 - Brkage of Fragile items
E018 - Brkage of Glass/Mirrors
E032 - R.O.D. cans.
Clauses:
C018 - Replacement Parts
C020 - Cutting Clause.
C021 - Pairs & Sets
C070 - Label Clause
W030 - Y2K
W031 - ISM Endt.
Deductibles

X003 - % on whole consignment EEL.
 

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