Marine Insurance - GRS Insurance Brokers Ltd.

1. General Details

Type of Goods/Asset to be insured

Country of Origin

Destination Country/Port

Date of Shipment or Expected Departure

Mode of Transport:

SeaAirLandMultimodal

Estimated Value of Cargo (₦ or $)

Currency of Trade

Description of Packaging (Crates, Containers, Pallets, etc.)

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2. For Marine Cargo Insurance

Is the cargo containerized? (Yes/No)

YesNo

Number and Type of Containers

Name of Vessel (if known)

Bill of Lading/AWB Number (optional

Any previous loss or damage history?

YesNo

If Yes, provide details

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3. For Goods in Transit

Type of Goods

OriginDetailed address

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DestinationDetailed address

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Nature of GoodsPerishable/Non-perishable

Mode of Local Transport:Truck / Van / Specialized Vehicle

Frequency of ShipmentOne-off / Regular

Estimated Value Per Trip

4.⁠ ⁠For Hull & Machinery Insurance

Type of VesselCargo ship, Tugboat, Barge, Fishing Vessel, etc.

Years Built

Flag State

Gross Tonnage

Area of OperationInland/Nigerian Coast/International Waters

Is vessel currently insured?

YesNo

If insured, Name of Insurer

Recent surveys or classification details

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5.⁠ F⁠or Freight Forwarder/Logistics Operator

Scope of OperationLocal / Regional / International

Coverage Interests:

YesNo

Claims History in Last 3 Years

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Subcontractor Management?

Third-party liabilityCargo loss/damageWarehouse coverLegal defence costs

Additional Information

Preferred Start Date of Cover

Duration of Cover Needed

One-time shipmentOpen cover / annual policy

Any additional requirements or notes?

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Declaration & Consent

I hereby declare that the information provided above is true and complete to the best of my knowledge and that I consent to the processing of this data for quotation and underwriting purposes.

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Contact Information

Your full name

Phone Number

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