Marine Cargo Notification Form

You will be contacted by a claims handler in due course, who will advise you of the claims reference number and any further documentation that is required in support of your claim.

Please note that fields marked with asterisk (*) are mandatory.

Claim details

Allianz Claim Reference

Claimant/Assure*

Policy Number (prefix)*

Policy Number*

Email Address*

Telephone

Brief Description of Event *

Carrier Involved *

Terms of Carriage*

Carrier Held Responsible*

Day Month Year

Documents available

Commercial Invoice & packing list *

Freight Invoice*

Original Transport documents: CMR Note, Bill of Lading, Airway Bill, Consignment Note*

Collection/Delivery Receipt - claused to note damages/missing items*

Photographs of damages - if applicable*

Copy of Police Report - if applicable*

Driver's statement - if applicable *

Consignment details

Weight of consignment in kg's

Weight of damaged/missing goods in kg's

Estimate of damage/loss

Amount

Carrier Settlement offer received?

Amount

Terms & Conditions

Please read and confirm acceptance of Allianz Terms & Conditions*

I accept Allianz terms and conditions

Allianz Insurance plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Financial Services Register number 121849

Marine Cargo Notification Form

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