Annual Marine and Transit Insurance - Renewal Declaration Form

Annual Marine and Transit Insurance - Renewal Declaration Form
Please complete the following information and submit this form to assist us in arranging and providing your insurance renewal.

All information you provide must be correct, true, and accurate as incorrect or misleading information may alter our quote and jeopardise cover if you proceed with a policy.

Please ensure you read the CGIB Customer Information Page before filling out this form. This includes essential documents such as our Financial Services Guide, General Advice Warning, Privacy Statement, and Duty of Disclosure.

If you are having any issues completing this form please contact our office on: 1300 764 244 or 03 8841 4200 and one of our Team will be able to assist you.
INSURED'S DETAILS
Insured / Business Name *
ABN *
Property Address *
Street Address
Postal code search*
Is Postal Address same as Property Address?*

YesNo
Postal Address *
Street Address
Postal code search*
Number of Employees*
Details

Worldwide Marine
Is cover required for your goods that you export and/or import
Total estimated annual imports to Australia for the next 12 months*
Largest any one import shipment to Australia for the next 12 months*
Actual total imports to Australia for the last 12 months*
Total estimated annual exports for the next 12 months*
Largest any one export shipment for the next 12 months*
Actual total exports for the last 12 months*
List all the countries you import from:*
List all the countries you import to:*
List all the types of goods you import and/or export*
Details

Transit within Australia
Is cover required for your goods in transit?
Total estimated annual sending's within Australia for the next 12 months*
Largest anyone sending within Australia for the next 12 months*
Actual sending's within Australia for the last 12 months*
List all the types of goods you send*
PREVIOUS Insurance
Have you ever suffered any losses or claims**

YesNo
Have you ever had any insurance cancelled or declined or special terms imposed*

YesNo
Have you ever been charged or convicted of any criminal offence or declared bankrupt*

YesNo
Are you aware of any matters not disclosed above that is relevant to the underwriters consideration of this insurance*

YesNo
Please provide all relevant information to all questions answered "Yes"*
CONTACT Details
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Comments / Additional Information
IMPORTANT INFO
By proceeding you agree to the Terms of Use of this site and that you have read and understood this Important Information about answering questions that we ask of you.
We will handle your personal information in accordance with our Privacy Policy.

Completion of this form does not put an insurance policy/cover in place - you will need to contact us to arrange insurance cover.
Other Insurance Needs
Do you require any further information on other insurances?

Office InsuranceManagement LiabilityLandlords CommercialLandlords ResidentialPublic LiabilityCyberMotor VehicleHome & ContentsPlant & MachineryTravelOther
* Mandatory Fields

Thank you for completing our online form.
We will endevour to contact you with your insurance details soon.
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Annual Marine and Transit Insurance - Renewal Declaration Form

INSURED'S DETAILS

Details

Details

PREVIOUS Insurance

CONTACT Details

IMPORTANT INFO

Other Insurance Needs