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Form 393A 1-58 4M

Appleton & Cox, Inc.
Underwriters and Managers
111 John Street
New York 38, N.Y.

STATEMENT OF CLAIM

S/S MAURETANIA

ClAIMANT: LEO CASTELLI
VOYAGE PARIS/NEW YORK
CLAIM NO. Z96/248
B/L # H-51
DATE Arr. 6/1/59

SHIPMENT 2 cases Paintings
INV. VALUE
INS. VALUE $6000.00
ADVANCE &/OR INS. VALUE PER 

POLICY CONDITION: ALL RISKS

NATURE OF CLAIM: DAMAGE

Gray Rectangle - Repairs $100.00
White Target - 75% Depre. 401.25
The Window - 75% Depre. 251.25
$752.50

COMPANY: MARITIME INSURANCE CO., LTD.
PAYS: $752.50
ASSURED: Messrs. W. Wingate & Johnston Ltd. 
CERTIFICATE: L59/5307 - L59/4955
NEW YORK

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