Agency Code*

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Policy No.	Transaction date	Start Date	Ref. Code (Agent / Broker)
FullName		Contact Name (If different from above)
Email		Tel. 1 (23480312345678)	Branch
			ABEOKUTA ABUJA ABUJA REGIONAL OFFICE ADO EKITI AKURE APAPA BAYELSA BENIN BIR - ONDO STATE CALABAR COMP-INS-LAG EVREG FLYCOOL-RETAIL HOGG-RETAIL IBADAN IKEJA IKOYI ILORIN JERICHO KADUNA KANO LAGOS LEKKI MICRO-INSURANCE NASSARAWA ONLINE ONLINE - ALL RISKS INSURANCE ONLINE MARINE OSOGBO OTTA OWERRI PORTHARCOURT RET-ABEOKUTA RET-ADOEKITI RET-AKURE RET-ASABA RET-BADAGRY RET-BAYELSA RET-BENIN RET-BENIN-BIU RET-CALABAR RET-ENUGU RET-FESTAC RET-GARKI RET-GBAGADA RET-GBAGI RET-IBADAN RET-IBADAN-FR RET-IJEBU-ODE RET-IKIRE RET-IKIRUN RET-IKORODU RET-IKOTUN RET-ILE-IFE RET-ILESHA RET-ILORIN RET-IWO RET-LOKOJA RET-MINNA RET-OFFA RET-OGBOMOSO RET-OGUDU RET-OGUDU-FR RET-OSOGBO RET-OWERRI RET-OYO RET-PORTHARCOURT RET-SAGAMU RET-SANGO-OTA RET-UMUAHIA RET-UYO RET-WARRI RET-YABA RETAIL HEAD OFFICE RETAIL-LAGOS RISK-LAGOS RTL-IKOYI SOKOTO VFS-RETAIL WARRI
Address		Occupation	TIN Verify tin
		AGRICULTURE AVIATION CIVIL AND LEGAL SERVICES CLERGY CONGLOMERATES CONSTRUCTION EDUCATION ENERGY ENGINEERING FINANCIAL SERVICES FMCG HEALTHCARE HOSPITALITY INFORMATION TECHNOLOGY RETIRED SECURITY SERVICES SELF EMPLOYED TELECOMS TRANSPORT
State	LGA	Identification	Number
ABIA ADAMAWA AKWA IBOM ANAMBRA BAUCHI BAYELSA BENUE BORNO CROSS RIVER DELTA EBONYI EDO EKITI ENUGU FCT GOMBE IMO JIGAWA KADUNA KANO KATSINA KEBBI KOGI KWARA LAGOS NASARAWA NIGER OGUN ONDO OSUN OYO PLATEAU RIVERS SOKOTO TARABA YOBE ZAMFARA	Ado-Odo/Ota	NATIONAL ID CARD PASSPORT DRIVER LICENSE BVN OTHER
Certificate (Serial) No		Type of Cover	Mode of Conveyance
		ICC'A' ICC'C' ICC(Air)	SEA AIR
Origin	Destination	Arival Date	Nature of Cargo
			General Merchandize Machinery
Proforma Invoice No.	Issuer of P.I.	Proforma Invoice Date	Client Type
			Individual Corporate Government
Proforma Invoice Value	Loading (%)	Proforma Currency/Rate	Packing Type
		NGN USD EUR GBP CHF RMB ZAR JPY CNY CAD AED CED XOF	Containerized Non-Containerized
Conveyance		Interest insured
ANY APPROVED STEAMER(S) AS PER NIGERIAN CLASSIFICATION CLAUSE		185 MT OF PVC SUSPENSION RESIN AS PER PROFORMA INV.NO. 190610B DATED: 10/06/2019
Marks & No.		Conditions (Clause)
NAME OF CONVEYING VESSEL AND MARKS & NUMBER OF PACKAGES/CONTAINERS MUST BE FURNISHED TO THE INSURERS IMMEDIATELY THEY BECOME KNOWN TO THE INSURED BUT NOT LATER THAN 3 DAYS OF DEPARTURE FROM PORT OF SUPPLY.		INSTITUTE CARGO CLAUSE A, CANCELLATION SUBJECT TO ADMINISTRATIVE CHARGE OF =N=1000.00 PAYMENT OF PREMIUM IS A CONDITION PRECEDENT TO LIABILITY AND NO RETURN PREMIUM THEREAFTER.
Exclusion		Loss Payee
WILFUL MISCONDUCT OF THE ASSURED INHERENT VICE OR NATURE OF THE SUBJECT MATTER AND MID STREAM DISCHARGE
Excess		Valuation Basis % Cost & freight Value / MPL (%)
EXCESS N______ OR 10% OF CLAIM WHICHEVER IS GREATER EACH AND EVERY LOSS
Sum Insured	Premium Rate%	Gross Premium	Curr. Rate
			NGN USD EUR GBP CHF RMB ZAR JPY CNY CAD AED CED XOF
Marine Policy Type	Coinsurance
SINGLE TRANSIT OPEN TRANSIT	YES NO

Additional Information ↑

THIS ONLINE MARINE INSURANCE DOES NOT COVER SUGAR, SALT, RICE, FISH, FROZEN FOODS AND CEMENT UNLESS WITH PRIOR AGREEMENT WITH THE COMPANY

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