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Marine Carriers Liability Claim Form
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Personal Information
Client Number*
Policy Number* (You can find your policy number on your renewal document, sent to you by your broker.)
Insurance Company*
The Insured
Name of policy holder*
Address of Insured*
Phone*
Fax
Email*
Name of the carrier's driver*
Licence details*
Were you the first actual carrier?*
Yes
No
Was any part of the journey subcontracted?*
Yes
No
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