1

Personal Details

2

Risk Details

3

General Policy Details

Personal Details


Male Female



Contact Details

Period of Insurance

Insurance coverage
Provide the below information (Note: At least one of the country must be “Ethiopia”.)
Point of loading?
Point of Off-loading?
*
*
*
*
Security of Vehicle(s)/Train(s)
Particulars of Vehicle/Train
Indicate whether the Vehicles/Trains are (tick as appropriate)

Vehicle Details

If cover is required on specified vehicles, please complete the schedule below.

Vehicle 1




Risk Details

Goods Item 1


Do you wish to purchase these?