Name*

Surname*

Contact Email*

Contact Number (Mobile)*

ID Card No*

Date of Birth*

Description*

Packaging (Specify if Professionally packed or otherwise)*

Voyage From*

Voyage To*

TranshipmentYesNo

Transport
AirfreightConventional CargoFull Load ContainerGroupageParcel PostTrailer

Departure Date*

Cost*

Freight

Customs Duty (If Applicable)

Import Levy (If Applicable)

10% Over-insurance

Loss Experience - Kindly Provide details of all losses in the last 5 years (whether insured or not)*

I have read, understood and agree with the terms related to Data Protection Policy*

By ticking this box I agree to have a Thomas Smith Group representative get in touch with me in relation to my request.*

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(Thomas Smith Insurance Agency will use the information you provide on this form to get in touch with you and to provide updates and marketing. You can change your mind at any time by clicking the unsubscribe link in the footer of any marketing email you receive from us, or by contacting us at withdraw@tcsmith.com. All personal information is kept strictly confidential and we will always ensure your personal data is protected. You can learn more about how GDPR may apply to you by reviewing our Personal Data Protection Policy .)