Annual Shipments Cover Form

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Have you had a shipper's interest (cargo) policy in the past?

Conveyance Size and Limits

Average Value

Maximum Value

Desire Limit of Liability

Any one Vessel or Aircraft

Any one single Container

Any one Truck or Railcar

Any one Shipment via Package, Mail or Parcel Post

Claims experience

Policy Year

Total Gross Losses

Number of Claims

2021-2022

2020-2021

2019-2020

2018-2019

2017-2018

Please Attach current carrier loss runs or complete our No Known or Reported Loss Letters

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