Complete this form to get a CargoCare quotation

Click here for an explanation and comparison of cargo insurance clauses (ICC A, B & C)

Value of shipment without shipping charges:

Cost of freight (Shipping Charges):

Name of Shipping Line:

Name of Vessel:

Goods shipped from Port or Place:

Goods shipped to Port or Place where goods will be offloaded from the above vessel:

If household goods &/or Personal Effects please provide as much detail as possible. After quotation Underwriters will require an itemized list and values per item:

Loss if any, payable to lienholder:

Goods packed:

Coverage requested:

Date of shipment or loading:

Length of voyage in days approximately:

I/we, as the duly authorized representative of the Assured and having full and complete knowledge of the facts herein do hereby request a quotation for insurance on the cargo completely and accurately described above. I/we understand Underwriters will rely on the accuracy and truthfulness of this request when issuing any quotation and this application shall be a basis for and form part of any insurance issued. I/we also understand no coverage is in force until confirmed in writing.