Transport Liability Insurance Proposal Form

Transport Liability Insurance Proposal Form

IMPORTANT NOTE: The questions contained in this form are designed to give Insurers information regarding your business. It cannot always cover every aspect and it is your duty to disclose all material information to insurers that may affect the premium or conditions.

1.  (Name of Insured), founded since (year),
and is managed by experienced executives working in the (industry) for over years.
Name of Co-insured (if any): .

2.  Number of Offices: (number) in (places).
Address of Head office: .

3.  Insured’s own Warehouses: (number), details as follows:

Location / Class * / Area
(square
feet) / Facilities **
CCTV / Burglary Alarm / Fire Alarm / Sprinklers / Strong room / Others
a
b
c
d
e
f
g
h
i
j

* concrete building / open area / others (please specify) ** tick as appropriate

4.  Insured’s own Vehicles: (number) running between (places).

5.  Total Number of Staff: .

6.  Trading Conditions and Documents: Attach copy of HB/L / HAWB / STC.

7.  Major Trading Area: Worldwide but mainly (%), (%) and (%).

8.  Major Cargo: General merchandise (%) such as . Dangerous Goods (if any, %). Reefer cargoes (if any, %). (%).

9.  Annual Cargo Volume estimates:

Freight Forwarder by Sea / Containerised
(including Groupage and LCL) / Breakbulk
As principal (under own HB/L) / TEU and cbm / cbm OR tons
As agent (under others’ B/L) / TEU and cbm / cbm OR tons
Overall / % port to port
% door to door
(Total: 100%) / % port to port
% door to door
(Total: 100%)
Freight Forwarder by Air / Own ULD / Coloading
As principal (under own HAWB) / kg / kg
As agent (under others’ AWB) / kg / kg
Freight Forwarder by Road/Rail / Containerised / Breakbulk
As principal (under own STC) / TEU / cbm OR tons
As agent (under others’ STC) / TEU / cbm OR tons
Warehouse Operator / cbm OR tons

10.  Annual Gross Freight Receipt estimates:

a.  Sea: USD or HKD

b.  Air: USD or HKD

c.  Road/Rail: USD or HKD

d.  Warehousing: USD or HKD

e.  Total: USD or HKD

11.  Name of Current Insurer (if any): .

12.  Claims History: Attach claims statement from current insurer. Or if not insured, declare as follows:

Date of incident / Nature / Amount claimed / Amount settled

13.  Company address: Tel:

14.  Company website:

15.  Contact Person: Email: Position:

23/F, Excel Centre, 483A Castle Peak Road, Lai Chi Kok, Kowloon, Hong Kong

Tel: 2299 5566 Fax: 2866 7096

E-mail: Website: www.sun-mobility.com

CIB A MEMBER OF THE HONG KONG CONFEDERATION OF INSURANCE BROKERS