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Cargo Application form - Blanka Panther
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Blanka Panther

Marine & Aviation Insurance Company

Cargo Application form

Insured
Name
Company
Address
E-mail
Phone
Shipper Consignee Freight–forwarder 
Cargo
Package Quantity
Weight
Carried by container trailer by air by sea by railroad multimodal 

 

Value

 

Condition ICC A (all risks) B (named perils) C (named perils) 

 

Route
From To
Via ( transshipment)
Period of cover
From to
Terms of contract of carriage (Incoterms) Name of the carrier
Additional information (oversized, fragile, hazardous and etc)