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Policy F,lo. Narne of gfeinlant Addrese

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B{L..RIR GCN" etc. No. and $*te
. : Name of Vessel -and/gr Co,nveyance From To Date of arflvet of Vffsetlg+ods at destlnatlon Date on v+'hichapplication was given to:'Fort Authorities for issue of shortlanding certificate (steamer shiprnets) External condition of the gooclsat the lime o{ takiirg delivery Baig of apptication for S.urueyl0pendelivery : by Carriers , Date Survey heldlapefi delivety obtained Who made the .sunrey / assessnlent . Date onwhich d*liv'ery was taken Da,te.of -

arrival of goods at final warehouse

Date of examinatisn of cont'en'tsin final warehouse Nanre of consigncr in the R.R./G.C.N. hlarne ofocsn$ignes in the .R.R./G.G.N. endorsed In whose favour was the R.R.IG.O.N:
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Whet risk notes, if f,ily, wre executedat the time of bookingt

Has the value, of the goods been Vendors? if so, when ? Detaits of loss damage *ignntr:';t:
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