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PROPOSAL FOR MARINE AND TRANSIT CARGO INSURANCE

IMPORTANT: It is responsibility of the proposer to ensure that the company is advised of all facts materials to the proposal. Complete answers to all questions are therefore essential, ticks or dashes are not sufficient.
Please complete in BLOCK LETTERS. Do not put a "DASH"
 
Agent
Name and Address of Proposer
Description of Goods (Please attach a copy of the invoice)
Number of Packages
Sum to be Insured (=N=)
Type of Packing
Marks on Packages
Voyage
Voyage From
Voyage To
Steamer and Sailing Date
Cover Required
   
N.B   For Household Goods and Personal Effects a complete valued inventory of articles should be supplied
   
DECLARATION: I/We the undersigned, being desirous of effecting an insurance as above described do hereby declare that the particulars of this Proposal are true, that, I/We have not omitted to disclose any materials fact, and I/We further agree that this Proposal and Declaration shall be the basis of the Contract between myself/ourselves and GUARDIAN TRUST INSURANCE COMPANY LTD. I/We undertake to advise the Company the name of carrying vessel before sailing date from the Port of departure. I/We further agree to accept a Policy subject to the terms, provisions and conditions of the Company.
   
Date
Signature
 

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