Name in which the vehicle is to be shipped:

UK contact address:

Telephone:

Email:

Make/model/year of manufacture:

UK registration number:

Vehicle chassis number:

Is the vehicle to be:

COLLECTED DELIVERED

Date of collection/delivery:

(dd/mm/yy)

Collection address (if applicable):

Vehicle to be handed over for shipment with a minimum amount of fuel.

Your date of departure from the UK:

(dd/mm/yy)

Shipment to (Port):

Your overseas contact address:

Telephone:

Email:

Do you require Standard Liability shipment protection?:

This valuation forms the basis of Karman Shipping Limited accepting "Standard Liability" in accordance with their Terms and Conditions (with particular reference to clauses 4, 9, 10, 11 and 12) which have been read and understood. An undeclared vehicle will be excluded from Standard Liability and Liability will be Limited in accordance with Clause 9.2 of the Terms and Conditions. The declared vehicle value should represent the full replacement value of the vehicle at destination.

YES NO

Declared value of the vehicle:

Any other instructions:

Upon receipt of this completed form Karman Shipping will prepare shipping documentation and an invoice (normally within 48 hours) and will forward copies to you for checking.

Shipment cannot be arranged without a photocopy of the UK registration document.

BY SUBMITTING THIS FORM YOU, AS OWNER OR AGENT, AUTHORISE KARMAN SHIPPING LIMITED TO PROCEED WITH SHIPMENT, AND AGREE TO ALL TERMS AND CONDITIONS.

Full name:

Date:

(dd/mm/yy)