Compass Marine Programs

710 Dacula Road, Suite 4A, #252

Dacula, GA. 30019

443-308-3003 P 410-685-3071 F

E

OCEAN CARGO APPLICATION

Today’s Date:

Applicant’sName:
Telephone No. / Facsimile No.
MailingAddress:
Business Address (if different):
Website:
Business Operations:
# of Years under present management:
Description of Operations:
Proposed effective dates of coverage / From: To:
Current Insurer:
Annual Gross Sales: $
Commodities:
Describe Commodities:
Packing: / [ ] New [ ] Used [ ] Export Packed [ ] Palletized [ ] Shrink Wrapped
[ ] Containerized [ ] Paper Carton [ ] Wood Crates [ ] Poly Bags [ ] Burlap Bags
[ ] Paper Bags [ ] Kegs/Barrels [ ] Metal Drums [ ] Fiber Drums [ ] Waterproof Liner
[ ] On Deck [ ] Bulk
Who packs the containers?
Are containers opened prior to reaching final destination? [ ] Yes [ ] No If so, by whom?
Do you use a freight consolidator? [ ] Yes [ ] No Freight Forwarder? [ ] Yes [ ] No
Name:
Valuation: [ ] Invoice + Freight + 10% [ ] Other:
Routes: [ ] Warehouse to Warehouse [ ] Worldwide [ ] River [ ] Great Lakes [ ] Land Bridge
Shipping:
Imports / Exports
Annual Volume (Imported/Exported) / $ / $
% of Shipments Applicant is responsible to insure / % / %
% Shipped by Air / % / %
% Shipped by Ocean / % / %
Shipments by Air / Avg. Amount per Aircraft / $ / $
Max. Amount per Aircraft / $ / $
Imports / Exports
Shipments by Ocean / Avg. per Container / $ / $
Max. per Container / $ / $
Max. per Conveyance / $ / $
Shipping Methods:
Imports / Exports
% shipped in Door-to-Door Containers / % / %
% shipped in Consolidated Containers / % / %
% shipped in Refrigerated Containers / % / %
% shipped in Bulk / % / %
% shipped Break Bulk / % / %
Limits of Insurance:
Avg. Value / Max. Value/Limit / How frequently do you ship?
Any One Package: / $ / $ / ______Shipments per week
______Shipments per month
______Shipments per quarter
Are your shipments seasonal?
Any One Container: / $ / $
Any One Vessel: / $ / $
Any One Vessel on Deck: / $ / $
Any One Aircraft: / $ / $
Any One Barge: / $ / $ / [ ] Yes [ ] No
Any One Truck or Train: / $ / $ / High Season:
Any One Package PP or Mail: / $ / $ / Low Season:
Insuring Conditions (Describe current coverages):
[ ] All Risks [ ] With Average _____% [ ] Free of Particular Average [ ] Other: ______
[ ] Deductible: $ ______[ ] Per Claim [ ] Per Voyage [ ] Other: ______
[ ] War [ ] SR&CC
Special Conditions: *=Reporting
[ ] Deposit $ ______M $______W [ ] Min Earned $ ______[ ] Banker’s Endorsement*
[ ] Block War* [ ] Bulk Reporting* [ ] Consequential Damage
[ ] Contingency* [ ] Domestic Transit* [ ] Exhibition
[ ] FOB/FAS Purchases* [ ] FOB/FAS Sales* [ ] Full Value Declared Air Warranty
[ ] Guarantee of Collectibility* [ ] Increased Value/Profits* [ ] NVOCC*
[ ] Profit Sharing* [ ] Refrigeration Breakdown [ ] Shortage from Containers*
[ ] Unpaid Vendor* [ ] Used Machinery [ ] Warehouse*
Details of Special Conditions checked above: ______
______
______
______
Premium and Loss History: (Please provide hard copies of loss runs, if available)
[ ] No losses in past 5 years
Policy Year / Premium / Paid Losses / Open Reserves / # of Claims / Description
Have you ever had policy coverage declined, cancelled, or non-renewed? [ ] Yes [ ] No
If yes, please explain:
Please Attach Copies of:
A)Current Cargo Insurance Policy
B)Company Loss Runs
C)Financial Statement
D)Narrative Details of Significant Losses
E)Product Brochures or Catalogs
I understand that the above information and supplemental information enclosed, which is correct to the best of my knowledge, is to be the basis of insurance if a policy is issued, but does not obligate the Applicant to accept the insurance nor oblige the insurer to effect insurance on the risk.
Applicant’s Signature: ______Date: ______
Applicant’s Title: ______
Broker/Agent Signature: ______Date: ______
Company Name/Branch: ______

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