Online Certificate Orders

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New Customer? Complete the form and we will contact you directly.

Name of Person Requesting Certificate:(Required)

Email(Required)

Phone

Full Commodity Description:(Required)

Is the coverage requested ICC Clause A All Risks or limited coverage ICC Clause C?(Required)

ICC Clause A

ICC Clause C

Is the Commodity New?(Required)

Yes

No

Full Container (FCL) or Less than Full (LCL):(Required)

Full Container (FCL)

Less than Full (LCL)

Breakbulk (cargo not in a container)

Bulk in Container (in a container, but no packaging)

Mode of Transport:(Required)

Air, Ground Carrier, or Vessel Name(Required)

Port of Exit

Port of Entry

Shipping Ref. Numbers:(Required)

Your ref. Number if any:

Sum Insured:(Required)

$ USD

Loss Payable To: (Name)(Required)

Name

Loss Payable To: (Address)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Ship Date:(Required)

MM slash DD slash YYYY

Shipping (Insured) From:(Required)

City State / Province / Region Country

Shipping (Insured) To:(Required)

City State / Province / Region Country

Is the Shipment Subject to Letter of Credit?

Yes

No

Please supply the Letter of Credit Wording Required on the Certificate

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