0LEASE ENSURE THIS ORM IS COMPLETED IN ALL 0ARTS APPLICABLE TO YOUR CLAIM 3UPPO R OFTHISFORM 68: chjgVcXZ A b iZY !. / ONNELL3TREET 3YDNEY. 37 !USTRALIA 0/ OX 3YDNEY. 37 !USTRALIA.

 

A. I. S. Insurance Brokers PtyLtd 137 Moray Street South Melbourne 3205 Telephone 03 8699 8888 Facsimile 03 8699 8899 Website www. aisinsurance.

 

Insured Contact Name Broker Telephone No. Policy No. Deductible Period of Cover From To.

 

Page 5 of 5 PRIVACY The Privacy Act 1988 requires us to tell you that we as broker and th e insurer collect your personal and sensitive information in orde r to calculate.

 

!!! !, -. / , In the event of loss or any potential loss situation or damage whic h may involve a claim under your insurance, immediate notification of such loss.

 

Chartis Insurance New Zealand Limited © Chartis. All Rights Reserved Page 1 of 2 Marine Cargo Claim Advice Claim Form Please print.

 

Form MN034 11/09.

 

Form MN034 11/09.

 

XA INSURANCE SINGAPORE PTELTD 8 ShentonWay 27 - 01 AXA Tower Singapore 068811 Tel: 63387288 Fax: 63382522 Internet: Co. Reg No. 196900406D 1of 3 This form is issued.

 

-1 - MARINE CARGO CLAIMFORM BASIC INFORMATION Information of the Insured and Claimant: Claimant: Address: Telephone No. : Fax No. : Email Address: Information of the Policy: Insured:.

 

LGI26 03/06 1. marine cargo and transit claim form Lumley General Insurance Limited, ABN 24 000 036 279, Lumley House Level 9, 309 Kent.

 

Claimant Name Claimant’s Ref No. Policy No. /Certificate No. Policy Issuing Office Correspondence Address E-mail Contact Person Contact No. Facsimile No. Name.

 

PAGE 1 MARINE CARGOCLNZN NZ3494/2 04/09 N.

 

Chartis Insurance New Zealand Limited © Chartis. All Rights Reserved Page 1 of 2 Marine Cargo Claim Advice Claim Form Please print.

 

A. B. N. 17 000 434 720 CARGO/GOODS IN TRANSIT CLAIM FORM THE INSURED Policy NumberPolicy Expiry Date Are you the owner of the lost/damaged goods YesNo If ‘No’, please provide.

 

IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED REGISTERED OFFICE: 34, NEHRU PLACE, NEW DELHI – 110019 Claim No. : _____________ Date of Issue: __________.

 

1 IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED REGISTERED OFFICE: IFFCO Sadan, C – 1, District Centre, Saket, New Delhi 110017 Claim No. : _____________.

 

1 IFFCO-TOKIO GENERAL INSURANCE COMPANY LIMITED REGISTERED OFFICE: IFFCO Sadan, C – 1, District Centre, Saket, New Delhi 110017 Claim No. : _____________.

 

    Cover.

 

Single Marine Cargo Insurance Policy Wording cargo EXPERTISE s SERVICE s SECURITY May 2009.

 

Page 1 of 44 cargo Annual Marine Cargo Insurance Policy Wording February 2010 EXPERTISE • SERVICE • SECURITY.

 

Annual Marine Cargo Insurance Features and bene ts EXPERTISE • SERVICE • SECURITY.

 

Page 1 of 44 cargo Annual Marine Cargo Insurance Policy Wording incorporating Institute Clauses February 2010 EXPERTISE • SERVICE • SECURITY.

 

Page 1 of 44 cargo Annual Marine Cargo Insurance Policy Wording February 2010 EXPERTISE • SERVICE • SECURITY.