Please leave us some StarsMarine cargo claim formMARINE CARGO CLAIM FORM The insured Name(s) of insured in full * Phone * Address Postcode Driver or person in charge of the vehicle Surname * Given name(s) * Mobile * Address Postcode Date of birth Age Driver's license no. Class State of issue Expiry date A photocopy of both sides if license and log book (where applicable) must be attached Front side Drop a file here or click to upload Choose FileMaximum file size: 134.22MB Reverse side Drop a file here or click to upload Choose FileMaximum file size: 134.22MB Log book Drop a file here or click to upload Choose FileMaximum file size: 134.22MBWas the freight being handled or controlled with the isured's consent ? * No YesWas any intoxicating liquor or drugs (includeing prescription drugs) consumed in the 12 ours preceding the accident or transit journey? * No YesDid the driver or person in control of the vehicle undergo a breathalyser / blood test / urine or oral fluid test / drug impairment assessment ? * No YesBreathalyser * No YesBlood test * No YesVehicle informationPRIME VEHICLE (if involved) Year Make Model Body Type Registration no. Expiry date TRAILER (if involved) Year Make Model Body Type Transit and incident detailsDate and time of transit Depature date Expected date of arrival at destination Freight in transit from (Please provide town and state): Freight transit to (Please provide town and state) Where is the freight now? Please provide details of depot/storage facility, town name and state: Please provide contact name and phone number at location Freight owner(s) claimant(s) details Name Mobile Address Postcode Were there any other carries reponsible for moving the freight No YesFreight owner(s) claimant(s) detailsWere you a subcontractor or principal carrier ? Subcontractor Principal/Sole carrierDetails of other vehicles / persons involvedRepeater Year Make Model Registration no. Owner detail: Driver details (if different from owner): The insurer's name Policy no plus1 Add minus1 RemoveDetails of cargo loss and claims made Please state the cause of damage or loss Please state the exact location where the loss or damage occured Who first noticed the loss or damage and when (date)? Were there any pre-existing damage to the freight * No YesIs there any other party who could be held reponsible for this loss or the cause of the loss * No YesWere the police notifed * No Yes Weight of load / truck cargo allowed to carried This section only to be completed if marine cargo claim is made against youRepeater Freight description Quantity Invoice or insured value plus1 Add minus1 Remove If you are human, leave this field blank. Submit
