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Im No: CARGO CLAIM FORM Insured Name: Address: Contact Person: Downloaded from www.insureatclick.com-Broker : Loyal Insurance Brokers Ltd. E-mail: Tel (s): Consignor / Consignee Fax: Mobile no Name Contact Person: E-mail: Fax: Tel (s): Mobile no Place and date of arrival Transport Details Place and date of departure Nature of Goods Name of Carrier/ forwarder Means of Transport Value of Goods Packing Number and Date of Carriers Receipts : Date when goods reached desti.

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