Cornerstone

Marine Insurance Claim

Policyholder Type *

Policy Number *

Phone No

Email Address *

Address *

City

State *

Port Of Origin *

Destination *

Lien

Date of Incident (yyyy-mm-dd) *

Time of Incident *

Where Did the Incident Occur? *

Brief Details of Incident *

Upload Picture 1 *

Upload Picture 2 *

Upload Picture 3 *

Superintendent Report *

Statement of claim(sheet showing quantities and value of goods damaged/lost) *

Original Bill of Lading *

Original Suppliers Invoice and Packing List *

Original Discrepancy Certificate *

Original Delivery Waybill *

Original NPA T Form 38 *

Customs Bill of Entry *

Estimate Of Claim *

Statement of Authenticity/Truth of Details Given Above (Please Tick Box). *