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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)	Tel.2
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		NATIONAL ID CARD PASSPORT DRIVER LICENSE BVN OTHER
Certificate (Serial) No		Type of Cover	Mode of Conveyance
		ICC'A' ICC'B' ICC'C' IFFC'A' IFFC'C' IFMC'A' IFMC'C' IBOC ICC(Air) INLAND TRANSIT	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		LABORATORY ITEMS: A CALIBRATION REAGENT, B STANDARD REAGENT, C CALIBRATION REAGENT, R REACTION REAGENT, ELECTRODE ACTIVATION REAGENT AND ELECTRODE DEPROTEINIZA REAGENT AS PER PROFORMA INV. NO. ADC-20041 DATED 24TH DECEMBER 2020.
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 CLAUSES (AIR), INSTITUTE WAR CLAUSES (AIR), INSTITUTE STRIKES CLAUSES (AIR), INSTITUTE RADIOACTIVE CONTAMINATION EXCLUSION CLAUSE, WARRANTED THAT CARGO IS PROFESSIONALLY PACKAGED, PAYMENT OF PREMIUM IS A CONDITION PRECEDENT TO LIABILITY.
Exclusion		Loss Payee
WILFUL MISCONDUCT OF THE ASSURED, MIDSTREAM DISCHARGE, LEAKAGES, DETERIORATION, FERMENTATION, CAKING, INHERENT VICE OR NATURE OF THE SUBJECT MATTER INSURED
Excess		Valuation Basis % Cost & freight Value / MPL (%)
N100,000 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	Profoma Document	Profoma Doc Number
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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