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Wx*trmremmremW COng ty Bio hi6m VietinBank ffA Cni Minh

$WSU&&Nfrffi

G Y U U H A VAN
APPLICATION FORM FOR CARGO INSURANCE

Kfnh giri : COng fy B6o Hi6m VietinBank HO Chi Minh Tel: (028) 38329861
To: Vietinbank Insurance Company Fax: (028) 3832 9893

D6 nghi C6ng ty 86o Hi0m VietinBank UO Chi Minh b6o hi6m cho 16 hdng theo nhu chi ti0t dudi
ddy (Please issue the insurance policy for our cargo with the detail as follows):
N["a'i Y/ciu b/hi6m Cong tv :
"6pfta"
tfriot'Ui ia" rrairrr Giang
Proposer
Eia chi : A8, Phan vdn Tri, Phucmg 10, Q. Gd v6p, TP. Ho chi Minh, viQtNam.
Address
Nguli thU hu&ng : C6ng ty c6 phAn thiet bi T6n Minh Giang
The beneficiary
Nguli li6n hQ Ms. : G6m
Tel: 0914 036 655
Person to contact
Lo3i hinh biohi6m : s Dudng bi6n I Duong hdrng kh6ng n Duong bQ
Insuronce Type (Marine Cargo) (Air Cirgo) (lnland Cargo)
SO ti6n b/hi6m : EUR 44,000.00
Amount Insured
Ccrs&ilinh giri : f tol% fittov, E roe f cnn M cm'
Based on the price of
Hing h6a ttuqc b/hi6m : Thi6t bi stra chira 6 t6 Werther
Commodities
Qui c{ch {I6ng g6i KiQn
Packing Type
Trgng tugrrg/Sii lugmg Kgs/dcm vi (units)
Wejght/quantity
Di6u ki6n b/hi6m ".At' .
Insuranbe Condition
Kh&i hinh ngiy Ngiy tli (ds ki6n): 22lltl20tg Ngny tl6n (ds ki6n): 0810112020
Sailing or on about date qruival date
Ti (from) Kho (ah) ffiCa,rg (port) n6tty ctngt4rt
Ddn fto) I<ho(l'tth) fl Cang @ort) ChngC6tl6i, HO Chi Minh, ViQtNam
Chuy6n tii Yes ENo
Transshipment 56 Neiv Dinh kim Gfri sau
No. Date Attached Send Later
Chring ttr li6n quan
Reference Documents
- Vfln dcrn
Bill of Lading (B/L)
d
- H6a don thucrng mai
Commercial Invoice
NM
- Danh muc hdng h6a M
Packing List (P/L)
- Tin dpng thu
Lettel of Credit (L/C)
trM
- Hqp d6ng mua bdn 06.19 ITMG-WERTHER ngdy 24109120t9
Sales Contract M f
Ngdv 019
Dai bf,o (For Proposer)

'.s C0NO TY c0

*l TtlIET Bl

mltmn rduc cmu Bdc


Ta'Vrm %on
BM 26.05
0U0312013 v

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