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MARINE CARGO POLICY

Policy No. :

SCHEDULE

NAME OF ASSURED : .

VESSEL: TO BE DECLARED SAILING ON OR ABOUT : TO BE DECLARED

VOYAGE : AT AND FROM TO BE DECLARED

AMOUNT INSURED HEREUNDER TO BE DECLARED

SUBJECT-MATTER INSURED : MARKS & NUMBERS :

AS PER SPECIAL MARINE CARGO OPEN POLICY CONDITIONS
(ATTACHED)

EFFECTIVE FROM :
TO : UNTIL CANCELLATION BY EITHER PARTY

Valued at the same as Amount Insured
CLAUSES, ENDORSEMENTS, SPECIAL CONDITIONS AND WARRANTIES :

AS PER SPECIAL MARINE CARGO OPEN POLICY CONDITIONS (ATTACHED)

The attached Clauses and Endorsements form part of this Policy
Claims, if any, payable at/in : DESTINATION
By AS SPECIFICALLY ON EACH CERTIFICATE

In the event of loss or damage which may involve a claim under this insurance, no claim will be admitted unless immediate
notice for survey has been given to and a survey report obtained from or with the approval of:

AS SPECIFICALLY ON EACH CERTIFICATE

In case where there is no Agents, the Lloyd’s Agents must be applied for
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□ ตัวแทน □ นายหน้าประกันภัยรายน้ ี …… …. ……. ใบอนญาตเลขท…………………….
Issued in Bangkok this Day of
WE, ........................................................(herein referred to as the Underwriters) hereby agree, in consideration of the payment to us by or on behalf of
the Assured of the premium as arranged, to insure against loss or damage liability or expense to the extent and in the manner herein provided,
IN WITNESS whereof the undersigned have subscribed their names for and on behalf of the Underwriters.

(......................................) (........................................) (........................................)
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กรรมการ-Director กรรมการ-Director ผู้รบมอบอ านาจ-Authorized Signature

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