Cargo Risks

Cargo Risks
The application form that follows is aimed to generate information regarding your operation’s exposure to risk and guide underwriters to provide the best package of cover and terms available. Please complete all relevant sections in full as accurately as possible as this may form a part of your future contract.
INSURED INFORMATION
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
VESSEL INFORMATION

CARGO INFORMATION
Please state the type of goods to be insured
Please state how the goods are packed
Value
USD
Please type of shipment method used

Other
VOYAGE INFORMATION
FROM
TO
Proposed date of departure

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Estimated date of arrival

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
INSURANCE COVER REQUIRED
All Risks
Total Loss
For Annual or Open products, please confirm:
Policy limits, maximum value any one:
USD
Conveyance:
USD
Location and/or loss:
USD
Specified storage:
USD
Third Party vehicle:
USD
Own vehicle:
USD
Postal sending:
USD
Number
USD
Estimated value of sending for the next 12 months:
UKto UK:
USD
UK to/from Western Europe, Scandinavia and/or Channel Isles:
USD
UK to/from Eastern Europe (excluding former USSR and Yugoslavia):
USD
UK to/from USA, Canada, South Africa, New Zealand, Australia, Japan, Hong Kong, Taiwan, South Korea and/or Singapore:
USD
UK to/from Middle East (excluding Iran, Iraq, Libya and Yemen):
USD
Other voyages: (please state all countries involved below):
USD
If other, please state any countries involved below:
CLAIMS INFORMATION
In the past 5 years, have any claims been made?

Rows	Date of Imitation	Total payment including losses	Total outstanding reserves	Open/Closed
Service Quality
Cleanliness
Responsiveness
Friendliness

VESSEL INFORMATION