Marine Kidnap, Extortion & Detention Insurance
INSURANCE & REINSURANCE BROKERS LTD.CO.
Extra War Risks Insurance (EWRI) - Proposal Form
Risk Area:Red Sea / Gulf of Aden / Indian Ocean and Gulf of Oman and
adjacent waters
Please fill in the blanks in the below form with Block capitals;
Name of Ship Owners :
Name of Ship Managers:
Business Website Address:
Name of person in charge
Phone No. of person in charge
E-mail address of company and person in charge
Name of Charterer : (if applicable)
VESSEL’S DETAILS
Vessel’s nameIMO-No.
Built
Vessel’s type
GT
DWT
Flag
Class
Freeboard duringTransit
Laden / Ballast ?
Type of Cargo (if laden)
Max. speed
Average speed
Service speed
Number and Nationality of crew
Officers: / Crew- / Others (please state)Voyage details
Port of Departure1st Port of Call
2nd Port of Call (if applicable)
Return Voyage Details (if available)
Next Port of Call2ndPort of Call (if applicable)
Will the vessel be registered with MSCHOA ? (
Yes / NoUKMTO Dubai will be notified ?
Yes / NoInternationally Recommended Transit Corridor and the Group Transit system used (Will the vessel be a part of organized convoy) ?
Yes / NoWill the “Best Management Practices” (BMP) applied ?
Yes / NoEstimated dates
ETA (Estimated date of arrival) at excluded areas ( Lat. 15° N / Long. 58° E / Long. 78° E / Lat. 12° S , whichever applicable)
Applicable Lat. or Long. / Date / Hour (UTC)ETD (Estimated date of departure) from excluded areas (Lat. 15° N / Long. 58° E / Long. 78° E / Lat. 12° S , whichever applicable)
Applicable Lat. or Long. / Date / Hour (UTC)K&R (Kidnap & Ransom) INSURANCE
Is Kidnap & RansomInsuranceavailable or required for the subject transit ?
Yes / NoIf yes;
Limit of K&R insurance obtained / required;
a)US$ 3,000,000
b)US$ 5,000,000
(Please tick as applicable)
Is K&R Loss of Hire Cover required ?
Yes / NoIf yes;
Daily Hire Amount required :
Number of days to be covered (60,90,120,180):
SECURITY PRECAUTIONS
1) Are the vessel’s fitted with Ship Security Alert Systems (SSAS), in compliance with SOLAS XI – 2 Regulation 6?2) If yes please provide name and type of equipment.
3) Is this equipment capable of real time tracking of your vessel through a graphical user interface (GUI) and web interface application?
4) How many position reports does your SSAS transmit on a standard basis per 24 hours?
5) What is the reporting frequency (number of minutes between each position report) of your SSAS units in alert mode?
6) Who responds to your ship board alerts? CSO, Flag, or other RO.
7) Does your vessel(s) have a valid International Ship Security Certificate (ISSC)?
8) Does your vessel routinely carry large amounts of cash onboard? If yes how much?
9) Where did your CSO, SSO and ship’s crew receive their security training?
10) Do your crew receive any formal training in counter – piracy measures or kidnap awareness?
11) Do your shore managers receive any formal training in contingency planning for security incidents, including piratical attacks, or kidnap ?
12) Do you have a corporate contingency plan for security incidents, including piratical attacks, or incidents?
13) Have your vessels been the victims or target of any piratical attack in the last 3 years, where the crew or vessel have been held hostage for more than 3 hours?
14) In high-risk areas (such as the Malacca Strait, East and West Coast Africa, East Coast of South America and the Caribbean) what are your standard counter-piracy measures?
15) Do you routinely employ security guards on board the vessel while in port, at anchor or at sea?
16) If yes, how many are employed? Are they armed? Which company provides the security guards?
17) Will the vessel be accopanied by a naval escort ? (no more than 3 vessels per warship for the whole length of the transit through the dangerous zone)?
18) Is the vessel registered with SSRS ?
.
19) Will the vessel be carrying military personnel from a recognised navy force on board during the whole length of the transit through the dangerous zone ?
20) Is the vessel fitted with razor wire around guard rails on low lying deck areas ?
21) Do the master and crew have a plan to retreat to a secure citadel onboard their vessel if boarded by pirates ?
Details of Anti Piracy Measures / Security Precautions taken on board (supported by pictures etc. if available)
THE UNDERSIGNED, IN HIS CAPACITY AS AN AUTHORIZED OFFICER OF THE APPLICAN, HEREBY DECLARES TO THE BEST OF HIS / HER KNOWLEDGE THAT THE INFORMATION SET FORTH HEREIN ARE TRUE AND NO INFORMATION HAS BEEN WITHHELD.
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