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Why Choose Mariners General Insurance Group?

Our knowledgeable staff has served the yachting community since 1959.
Insuring with the BEST does not cost more!

 
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Online Agent/Broker Cargo Insurance Application

Agent/Broker Info:
Agent/Broker Name *
Address *
City *
State *
Zip Code *
Email Address *
Phone Number *
Fax Number *

Applicant Info:
Applicant Name *
Address *
City *
State *
Zip Code *
Phone Number *
Email Address *
Website
Business of Assured *
Years in Business
Principle Commodities *
Packaging *
If other, please specify
Who packs the container/
How is it packed?
Method of
Container Service *
Valuation *
If other, please specify

Limits of Insurance:
Any one vessel (on deck) *
Any one vessel (under deck)
Any one domestic
Any one aircraft
Any one barge
Any one Truck/Rail
Any one package Fed Ex/Ups
Any one parcel post

Shipment Values:
Shipment Type (Import)
Last 12 Months *
Next 12 Months *
Average Value Per Shipment *
Annual Values Shipped
Details of Shipment:
From City & Country
To City & Country
Percentage by Air
Percentage by Vessel
(Air & Vessel should equal to 100%.)
Shipment Type (Export)
Last 12 Months *
Next 12 Months *
Average Value Per Shipment *
Annual Values Shipped
Details of Shipment:
From City & Country
To City & Country
Percentage by Air
Percentage by Vessel
(Air & Vessel should equal to 100%.)
Shipment Type (Domestic)
Last 12 Months *
Next 12 Months *
Average Value Per Shipment *
Annual Values Shipped
Details of Shipment:
From City & Country
To City & Country
Percentage by Air
Percentage by Vessel
(Air & Vessel should equal to 100%.)

Warehouse Coverage:
1. Warehouse Address
Building Construction
Additional Details:
Year Built
Sq. Ft.
Sprinkler
Central Alarm
Average Limits
Max Limits
2. Warehouse Address
Building Construction
Additional Details:
Year Built
Sq. Ft.
Sprinkler
Central Alarm
Average Limits
Max Limits
3. Warehouse Address
Building Construction
Additional Details:
Year Built
Sq. Ft.
Sprinkler
Central Alarm
Average Limits
Max Limits

Loss History:
Loss History (Last 5 years) *
(If yes, please input data.)
1. Loss Description Details
Year
Loss Paid
Loss Pending/Closed
2. Loss Description Details
Year
Loss Paid
Loss Pending/Closed
Current Insurance Carrier
Current Deductible
Desired Deductible
How did You hear about us
Additional Comments or Questions,
(Please specify additonal
warehouse/loss history here.)
Security Code