FREIGHT FORWARDERS’ LIABILITY INSURANCE

Contents

I. DETAILS OF APPLICANT

II. DETAILS OF BUSINESS

III. FINANCIAL DETAILS

IV. DETAILS OF INSURANCE COVER

V. CLAIMS DETAILS

VI. DETAILS OF INSURANCE COVER

VII. DECLARATION AND SIGNATURE

SPECIALIST proposal

IMPORTANT

? This form may be completed by your authorised insurance broker

? If you have insufficient space to answer any questions, please attach a separate sheet

YOU ARE TO DISCLOSE IN THIS PROPOSAL FORM, FULLY AND FAITHFULLY, ALL THE FACTS WHICH YOU KNOW OR OUGHT TO KNOW, OTHERWISE, THE POLICY ISSUED HEREUNDER MAY BE VOID.

A. DETAILS OF APPLICANT

1. Company name and address:

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2. Subsidiary companies to be named in the insurance:

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NB. If subsidiary companies to be named, the information provided in this proposal form must include their activities

3. Date company established: ........................................................

B. DETAILS OF BUSINESS & PERSONNEL

1. Trade Associations:

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2....... Names and qualifications/years experience of directors and senior managers:

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3. Employees:

(a) Number of directors, senior managers

(b) Number of clerical employees

(e) Total

4. Services to be insured

Please tick the services you provide to your customers:

No. of years Approx. % of annual Turnover*

(a) Ocean freight forwarder/NVOC q ............ ...........................................

(b) Air freight forwarder/air cargo agent q ............ ...........................................

(d) Road haulier q ............ ...........................................

(e) In-transit warehousing q ............ ...........................................

(f) Packing/ consolidating q ............ ...........................................

(g) Other (please detail) q ............ ...........................................

C. FINANCIAL DETAILS

1. Please fill in table below

* Turnover = gross freight receipts, income or revenue but should exclude duty, taxes or disbursements paid on behalf of your customer.

What was your annual turnover (for the services to be insured) for the last financial year

What is your estimated annual turnover for this financial year

Please forecast your annual turnover for the next financial year

Currency ...........................

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2. Below are questions for companies providing any freight forwarding service (ocean or air), haulage, warehousing or packing service.

(a) Please estimate what percentage of your annual turnover is paid to

independent Road Hauliers, Warehousekeepers, Consolidators, Packers: %

(b) What percentage of your annual turnover results from carriage of cargo which is :

Breakbulk % Approximate tonnage

Containerised % Approximate number of TEU's

Palletised % Approximate tonnage

3. Please estimate the percentage of your annual traffic to or within each of the following areas:

Europe ..................... % North America %

Middle East ..................... % Africa %

Australasia ..................... % Far East %

Central & Sth America ..................... % Indian Sub-continent %

4. What percentage of your annual turnover is represented by:

Refrigerated cargoes ..................... % Tobacco Products %

Tank containers ..................... % Project cargoes %

Spirits ..................... % Dangerous cargoes %

High value goods ..................... %

(eg computers, jewellery, cameras, TVs, audio equipment, mobile phones)

5. Do you have a Customs bond? YES q NO q

6. What percentage of your turnover relates to cargo carried under your own house bill of lading and / or house airway bill? %

7. If you operate your own vehicles, warehouse(s) or packing/consolidation facility(ies):

7.1 Number of employees (including directors) involved in any of the above services:................................

7.2 Property you own or lease or operate:

Location	Services provided	Age	Describe security
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Vehicles: Description	Cargo carried	Delivery radius
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8. Please describe the Cargo handling equipment used:

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9. Do you hire to others? YES q NO q

10. Please tick the conditions of business and documents you currently use:

10.1 Conditions of business:

(a) Own standard conditions – please attach a copy q

(b) National forwarding association conditions q

(d) Other (please specify)

10.2 Bills of lading issued in your own name:

(a) FIATA B/L q

(b) Own house B/L – please attach a copy q

10.3 Other documents in your own name:

(a) FIATA AWB q

(b) House airway bill - please attach a copy q

(d) Other (please specify)

D. DETAILS OF INSURANCE COVER

1. Please tick the insurance cover you require:

(a) Liability cover if you do not issue your own bill of lading q

(b) Liability* cover including issuing your own bill of lading q

*referred to by some other insurers as bill of lading liability

(d) Liability for fines and penalties q

2. Forwarders’ errors and omissions:

(a) Basic cover for liability for incorrect or wrongful delivery of Cargo or delay in the handling

of your Customer’s Cargo only; or q

(i) Liability for customers’ financial loss q

E. CLAIMS DETAILS

1. In the last five years have any:

1.1 Cargo or statutory liability claims been made against you? YES q NO q

1.2. General third party liability claims been made against you? YES q NO q

1.3 Professional indemnity (errors and omissions) claims been made against you? YES q NO q

1.4 Circumstance arisen that could have resulted in any of the above liability claims

being made against you? YES q NO q

1.5 If YES to any of the above, please provide details

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F. DETAILS OF INSURANCE COVER

1. Are you currently insured for liability risks? YES q NO q

1.1 If so, by whom and what is your current limit, deductible and premium?

2. Do you require a specific limit of liability and/or deductible to be quoted? YES q NO q

G. Declaration and Signature

We declare that the information and answers given in this form are true to the best of our knowledge and belief and that we have not misstated or suppressed any material facts that might influence the assessment of the risk. We also understand that completion of this form does not bind insurers or mean we will accept this insurance but, if terms are agreed, it will form part of the contract.

Name..................................................................... Position...........................................................................

Signed................................................................... Date................................................................................