Freight Liability Insurance "*" indicates required fields Step 1 of 9 11% The following questions are to enable Insurers to assess the risk. You must take reasonable care to provide complete and accurate answers to the questions asked. You must provide a fair presentation of the risk to Insurers disclosing all material information. Please read any assumptions carefully and confirm if they apply to your circumstances. We recommend that you keep a record (including copies of letters) of all the information you provide to us for your future reference. A copy of the completed application form will be supplied to you on request within a period of three months after its completion.Company informationPlease specify if you are involved in any of the following cargoes and indicate percentage of turnover that relates. Company name* Address* Street Address* City* Post Code* Contact informationContact name* Telephone number*Email* Website Provide details of any associated company or subsidiary company or trading name to be included:Provide details of any other premises from which the company operates:How many years has the company operated? Provide full names of Principals and/or Directors of the company: Add RemoveTo add more names click the plus iconConfirm numbers of staff that areWorking Partners or Directors Managers Clerical/ Administration Warehouseman Drivers Other Business ActivitesBusiness Description (e.g. Freight Forwarder / NVOCC / Haulier / Courier / Warehousekeeper / Pick & Pack etc.)Trading conditons (e.g. BIFA / RHA / CMR / UKWA etc or if own conditions please supply a copy)Estimated Annual Company Turnover (charges net of Duty and VAT): What activities do you undertake?What activities do you undertake? Airfreight Seafreight Road Haulage – UK own vehicle Road Haulage – UK subcontracted Road Haulage – International own vehicle Road Haulage – International subcontracted Warehousing – Own warehouse Warehousing – Subcontracted Customs Clearance Packing Courier Other AirfreightTrading ConditionsPercentage (%)or TurnoverSeafreightTrading ConditionsPercentage (%)or TurnoverRoad Haulage - UK own vehicleTrading ConditionsPercentage (%)or TurnoverRoad Haulage - UK subcontractedTrading ConditionsPercentage (%)or TurnoverRoad Haulage - International own vehicleTrading ConditionsPercentage (%)or TurnoverRoad Haulage - International subcontractedTrading ConditionsPercentage (%)or TurnoverWarehousing - Own warehouseTrading ConditionsPercentage (%)or TurnoverWarehousing - SubcontractingTrading ConditionsPercentage (%)or TurnoverCustom ClearanceTrading ConditionsPercentage (%)or TurnoverPackingTrading ConditionsPercentage (%)or TurnoverCourierTrading ConditionsPercentage (%)or TurnoverOther (please specify)Business ActivityTrading ConditionsPercentage (%)or Turnover Add RemoveTo add more activities click the plus iconProvide details of turnover split between:Imports Exports Domestic Cross Trade Warehousing Other What geographical trading areas do your main services cover?What geographical trading areas do your main services cover? UK EU Baltic & Former CIS USA & Canada Africa Far East Middle East Australasia India Sub-continent Central & South America UK EU Baltic & Former CIS USA & Canada Africa Far East Australasia Middle East India Sub-continent Central & South America Cargo TypesPlease specify if you are involved in any of the following cargoes and indicate percentage of turnover that relates. If YES please provide additional information to specify types of cargo and operationsTemperature Controlled Yes No Percentage of Turnover Additional Information Hazardous Yes No Percentage of Turnover Additional Information Project Cargoes (breakbulk / out of gauge) Yes No Percentage of Turnover Additional Information Category A or B Export Control Licensed Goods/Weapons or Ammunition Yes No Percentage of Turnover Additional Information Bulk Cargoes (e.g. unpacked grains/liquids) Yes No Percentage of Turnover Additional Information Private Individuals Yes No Percentage of Turnover Additional Information Excluded GoodsThe following goods are excluded from cover unless Insurers agree to cover and this is noted on the policy schedule:Living Creatures and/or Plants Yes No Percentage of Turnover Additional Information Bullion and Currency Yes No Percentage of Turnover Additional Information Deeds, Bonds, Stamps, Securities, Manuscripts, Documents & Plans Yes No Percentage of Turnover Additional Information Pre-paid phone cards, gift cards and the like Yes No Percentage of Turnover Additional Information Precious metals & stones Yes No Percentage of Turnover Additional Information Jewellery Yes No Percentage of Turnover Additional Information Human Remains Yes No Percentage of Turnover Additional Information Restricted Goods / Theft Attractive GoodsIndicate as followsFurs Yes No Percentage of Turnover Additional Information Watches Yes No Percentage of Turnover Additional Information Non-ferrous metals in raw & scrap form Yes No Percentage of Turnover Additional Information Computer chips in isolation Yes No Percentage of Turnover Additional Information Consumer Electronics Yes No (laptops, tablet computers, mobile phones or similar personal electronics)Percentage of Turnover Additional Information Plasma Screens Yes No Percentage of Turnover Additional Information Wine & Beers Yes No Percentage of Turnover Additional Information Spirtis Yes No Percentage of Turnover Additional Information Tobacco & Cigarettes Yes No Percentage of Turnover Additional Information Detail any other theft attractive goods other than mentioned above What documents do you issue?If YES confirm percentage of turnover which relatesHouse Bill of Lading Yes No Percentage of Turnover Own Bill of Lading (NVOCC) Yes No Percentage of Turnover FIATA Bill of Lading Yes No Percentage of Turnover House Air Waybill Yes No Percentage of Turnover CMR Notes Yes No Percentage of Turnover Collection Note Yes No Delivery Note Yes No Any other documents? Yes No Please specifyT-Forms (T1) / C1 Documents (for Customs purposes/duty) Yes No Number issued per annum* or any other document where you would be liable for Duty) Limit required per form* How do you incorporate trading conditions into your contracts?How do you incorporate trading conditions into your contracts?(this is a Condition Precedent of the policy and failure to incorporate can result in claims not be met under the policy - see our Information Guide ).Do you require cover for any contract agreements which either deviate from standard trading terms or where increased liability levels are required?Do you require cover for any contract agreements which either deviate from standard trading terms or where increased liability levels are required? Yes No Please provide details of such contracts (liability limit required / type of goods / geographical requirements / annual charges applicable etc.)?Do you check your sub-contractors’ insurance on an annual basis?Do you check your sub-contractors’ insurance on an annual basis? Yes No these checks are a condition of the policy and failure to do so can result in claims not be met – see our Information GuideSpecial or unusual requirementsDo you have any special or unusual requirements that are unique to your business that may affect the insurance cover? Yes No (e.g. operational factors that differ from industry standard / recent or planned business developments / acquisitions / new customers or contracts / known issues of concern / changes in business operationsProvide details Vehicles and equipmentDo you operate your own vehicles for carriage of goods? Yes No Provide detail of all vehicles (vehicle type/carrying capacity)*Vehicle typeCarrying capacity Add RemoveTo add more vehicles click the plus iconWhat types of goods are carried (specify any theft attractive/hazardous/temperature controlled) Add RemoveTo add more types of goods click the plus iconWhere are vehicles operated? UK EU Other (please specify) Vehicle operations*Do you require cover for your own (including hired, leased, loaned) equipment such as trailers, containers and/or similar equipment? Yes No Please provide full list of equipment to be insured (make/model/age/current market value) WarehousingDo you arrange contract warehousing services (charges raised for goods held which are not in the ordinary course of transit): Yes No Is this at your own warehouse premises Yes No Is this contract warehousing at a subcontracted warehouse location Yes No If subcontracted warehouse locations are used provide details of the warehouse locationsWarehouse premises informationFull addresses of any warehouse locationsIs this warehouse sole or shared use? Sole use Shared use Please details of other tenants, types of goods, segregation provided and access to buildingDetail materials of which the build is constructed fromRoof Walls Floors Stairs Square Footage Age Maximum Tonnage Capacity Average Tonnage Capacity Manned Operating Hours Any history of flood/subsidence/strom Detail adjoining properties or properties located within 30mAre adjoining properties occupied Yes No Occupation of adjoining tenantsWhat type of goods are stored (specify any theft attractive/ hazardous/ temperature controlled)Detail physical security at each premises (for example detail alarms/locks/gates/fencing/patrols/CCTV etc.)Are all goods kept in an enclosed warehouse? Yes No Provide detailsDo you have a security alarm? Yes No Name of Alarm Company Type (e.g. GSM Redcare) Alarm Grade Signalling method Signal Grade Connected to monitoring stationPlease select...YesNoPolice responsePlease select...YesNoDo you have a fire alarm? Yes No Category (e.g. L1/P2/M) Signalling method Connected to Monitoring StationPlease select...YesNoConnected to Fire BrigadePlease select...YesNoIs a sprinkler system fitted?Please select...YesNoType and Number of extinguishers Type of Heating System Are all systems maintained in good working order and in full operational order? Yes No Are idle pallets or other combustibles (including waste bins) stored at least 10m from the building Yes No Date of last Fixed wiring periodic assessment (within last 5 years) DD slash MM slash YYYY Date of last Portable Appliance Test (PAT) DD slash MM slash YYYY Is this a bonded or ERTS approved facility Yes No Do you have AEO approved status Yes No Limit & Excess Level RequirementsWhat limit of liability do you require for:The loss and damage limit should represent your maximum liability under applicable trading conditions or International Conventions. For example, what is the maximum tonnage exposure you would have either in transit or at a single warehouse location? Take this tonnage exposure and calculate the compensation based on the conditions applicable, BIFA Liability 2 SDR’s per kilo, CMR Liability 8.33 SDR’s per kilo, UKWA GBP100 per tonne or RHA GBP1,300 per tonne. You may wish to consider higher limits to cover the possibility of trading conditions being set aside or in the case of wilful misconduct or gross negligence where limitations would not apply. Do you need higher Errors & Omissions limits dependant on your company exposures? Give us a call if you need assistance calculating your required levels.1) Loss of Damage to Good? GBP 2) Errors & Omissions?(i) GBP - each claim (ii) GBP - in the aggregate What excess level would you accept for:1) Loss of Damage to Goods? GBP - each and every loss 2) Errors & Omissions (E&O)? GBP - each and every loss ClaimsAre you currently insured? Yes No Name of Broker Name of Insurer Renewal Date DD slash MM slash YYYY Has any application for insurance ever been declined by insurers or has any such insurance ever been cancelled or had special terms imposed Yes No Provide detailsHas any claim been made against your company in the past five years in respect of loss or damage to goods and or in respect of any error and omission (whether or nor notified to Insurers) Yes No InsuranceClaimsIncident dateClaim forAmount paidAmount outstanding Add RemoveTo add more claims click the plus button DeclarationI/We declare that to the best of my/our knowledge and belief:- The sums represent the full values. The premises are and will be kept in a good state of repair. Neither I nor any person whose property is to be insured hereunder have been:- convicted of arson or any offence involving dishonesty of any kind (e.g. fraud, robbery, theft or handling stolen goods) prosecuted under the Factories Act or the Health and Safety at Work Act or any similar legislation. ever been declared bankrupt or the subject of bankruptcy proceedings or made any arrangement with creditors either in a personal capacity or in connection with any company, business or firm with which any of you have been involved. been involved in any legal disputes during the past 5 years in connection with any company, business or firm with which any of you have been involved. The information you have provided in this form contains statements upon which Underwriters will rely when deciding whether to accept this insurance and the terms on which it may be offered, including the amount of premium payable. If you are in any doubt at all regarding any of the answers you have given, you should ask your broker. You must tell us within 14 days of you becoming aware if any of the information provided by you changes after you purchase your policy and during the period of your policy. You are required to provide a fair presentation of the risk to Underwriters. This should include all relevant knowledge and information of the senior management (including key individuals who decide how business is run), the risk and insurance team (or individual responsible for purchase or insurance) and/or your insurance brokers. You should also conduct sufficient enquiries with external third parties (such as facilities management companies/alarm providers/accountants/ brokers). An audit trail should be maintained to evidence who was consulted, what information was requested and how information was collated and checked. If you breach your duty to provide a fair presentation and such breach was deliberate or reckless, Underwriters may regard the policy as void and are not required to return any paid premium back to you. If the breach was not deliberate or reckless, Underwriters remedy shall depend upon what Underwriters would have done if you had complied with the duty of fair presentation:- Underwriters may regard the policy as void if they would not have entered into the policy on any terms in the absence of the breach. In this case, the Underwriters must return the premium paid. If the Underwriters would have entered into the policy, but on different terms (other than terms relating to premium) the policy is to be treated as if those different terms applied from the outset, if the Underwriter so requires. If the Underwriters would have entered into the policy but would have charged a higher premium the Underwriters may reduce proportionately the amount to be paid on a claim (and, if applicable, the amount already paid on prior claims). DECLARATION To the best of my knowledge and belief the information provided in connection with this proposal, whether in my own hand or not, is true. Data Protection Act 1998 – Proposer’s Consent Clause By signing this Proposal Form I/We hereby consent to any information you may have about me/us being processed by you for the purpose of providing insurance and claims handling which may necessitate you providing such information to third parties.Signed*Name Position* Dated* DD slash MM slash YYYY 40793
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