Insurance Application Form

(*) "Send" button will be functional once all the required fields are completed.

Please fill in all the required fields to receive an accurate quote as soon as possible.


Supplier Information

Beneficiary Information

Consignee Information

This information is required when the consignee is different from the beneficiary.

Cargo Information

Insured Amounts

Mode of Transport


The shipment information provided for the quote must be true and correct, and any changes must be informed in advance or we will be entitled to deny coverage.