Marine Claim Form – Custodian and Allied Insurance

Marine Claim Form

Jobs, Recruitment & Employee Growth.

Policy Holder Name

Policy Number

Policy Type

Sub Risk

Creation Date

Email

Phone Number

Date and Time of Incident

Incident Location

Description of Incident

Cargo Description

List of Stolen Items / Damaged Cargo

Do You Have a Witness?

Witness Contact Info

Has the Police Been Informed?

Police Station / Marine Authority Address

Claims Amount

Estimated Loss Amount

Supporting Documents

Evidence Upload 1

Max size: 10MB. Accepted: PDF, JPG, PNG

Evidence Upload 2

Max size: 10MB. Accepted: PDF, JPG, PNG

Evidence Upload 3

Max size: 10MB. Accepted: PDF, JPG, PNG

Evidence Upload 4

Max size: 10MB. Accepted: PDF, JPG, PNG

Eye Witness Report

Max size: 10MB. Accepted: PDF, JPG, PNG

Police Report

Max size: 10MB. Accepted: PDF, JPG, PNG

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