Single Marine Transit

Single Marine Transit

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Your Details		Trip Details		Disclosure		Declaration

- If you are moving house and want coverage for your contents, please complete our Household Removal Insurance form.
- Your Details
Are you a prospective new client or an existing client of All Star Brokers Pty Ltd? *
N/A

Prospective Client
Existing Client
a) Is this Quote for new cover or a Renewal? *
N/A

Renewal
Quote
Expiry Date *
N/A

dd-MMM-yyyy
Contact Details
1. Contact Name
N/A

Required First Last
2. Phone Number *
N/A

e.g. 02 1234 5678 or 0411 222 333
3. Email Address *
N/A

We will send a copy of your answers immediately to your inbox, and a quotation to you shortly based on full completion of form.
Insured Details
1. Insured Name/s (Legal Entity to be insured) *
N/A
2. Trading Name (if applicable)
N/A
3. ABN
N/A

(Website: https://abr.business.gov.au/ to assist)
4. Address
N/A

Required
Street Address City State/Territory
Post Code

Disclosure
1. In the past 3 years have you had any insurance declined, cancelled, refused or special conditions/terms imposed or claim refused? *
N/A

Yes
No
If 'Yes', please advise *
N/A
2. In the past 3 years have you had any claims, incidents, accidents or events that gave rise or could give rise to a Cargo insurance claim? *
N/A

Yes
No
If 'Yes', please advise
-- No Fields Available --
- Date of Loss
- Loss Amount
- Description
Add Entry Add Entry
- Date of Loss
  N/A
  
  dd-MMM-yyyy
- Loss Amount AUD
  N/A
- Description
  N/A
- Date of Loss
  N/A
  
  dd-MMM-yyyy
- Loss Amount AUD
  N/A
- Description
  N/A

Your Details