Goods in Transit - Insurance Hub

GOODS IN TRANSIT INSURANCE PROPOSAL FORM FOR INSURANCE OF GOODS IN TRANSIT BY ROAD, RAIL OR INLAND WATER WAYS IN FEDERAL REPUBLIC OF NIGERIA

First Name

Last Name

Phone no.

Email

Business/ Occupation

Preferred Method of Contact

Phone

Email

other

Residential Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Insurance start date

Insurance end date

Do you want this insurance as....

If you have other insurance with the Company please specify

Give details of losses or damage in respect of goods in transit relating to you during the last three years, indicating amounts

State fully the nature and description of goods to be carried

State the area in which the vehicles operate in the ordinary course of business

Has any insurer ever

Will any of the following be carried?

What safety device do you have in your vehicles?

Estimated Total value of goods to be carried in any one year (NGN)

Maximum consignment anyone vehicle or conveyance

If this insurance is for a single consignment please indicate total value of goods being transported (in NGN) from the starting point to the destination

Specify the Starting Point

Specify the destination

By submitting this form I/We desire to effect an insurance in the terms of the usual Policy for Goods In Transit Insurance
and declare that the above statements and particulars are true. I/We further declare by submitting the form that this
proposal shall be the basis of the contract between me/us and Alliance & General Insurance
Company Ltd. I/We also are aware that our failure to insure for the full value of the property will
result in I/We receiving only a proportion of any amount that may be due in the vent of a loss or
damage