Certificate of Insurance Requestadmin2021-04-25T17:30:19-05:00 Beneficiary Name* Address* City* State* Country* Zip Code* Consignee Name (If different than beneficiary ) Address City State Country Zip Code Departure Date DD slash MM slash YYYY Arrival Date DD slash MM slash YYYY Declared Value*Duty Insured ValueFreight & Other ExpCIF ValueCIF Markup (max. 10%)Insured Value*Description/ CommodityOrigin (City, State/Province & Country)* Destination (City, State/Province & Country)* ConveyanceAirOceanTruck/RailCoverageAll riskTotal LossVessel / Airline / Trucking company Voyage / Flight # Port of Loading OR Airport of Loading Transhipment (if applicable):Port of Discharge OR Airport of Discharge: Project / Ref / Inv # (Optional ): # Bill Of Lading / AWB/ Carta Porte: Invoice # Prepared by: Date DD slash MM slash YYYY
