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Goods In Transit Insurance Claim
Policy Owner Details
Policyholder Type
*
Please Select
Private
Corporate
Policy Number
*
Phone No
*
Email Address
*
Address
*
City
*
State
*
Goods Details
Brief Description of Goods Carried
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Value of Goods Damaged/Lost
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If Damaged,Where They Can Be Inspected?
Transit Details
Origin of Transit
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Destination of Transit
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What is the Medium of Conveyance?
*
Owned or Hired?
*
If Medium is Vehicle, Please Specify Make and Registration No
Details of Incident
Where Did the Incident Occur?
*
Date of Incident (yyyy-mm-dd)
*
Time of Incident
*
Brief Description of Incident
*
Pictures of Incident/Damaged Goods
All Attachments Must be In PDF or JPEG Format
Upload Picture 1
*
Upload Picture 2
*
Upload Picture 3
*
Upload Supporting Documents(if any)
Delivery Waybill/Invoice
*
Statement of claim (sheet showing quantities and value of goods damaged/lost)
*
Statement of Authenticity/Truth of Details Given Above (Please Tick Box).
*
Submit
