Freight Services Liability Questionnaire

Name of Insured

Address

City

State/Province

Zip/Postal Code

Country

Phone number

Fax

Email Address

Other offices

Year Formed

Number of Employees

Number of Directors/ Partner

Are you a member of any trade association ?        Yes  No

 

If yes, please provide details:


Please provide any background or general information on the company

Operational Information

Please describe the main areas of your business and trading conditions:

  Percentage (%) Conditions Attached
Freight Forwarder as Agent
Freight Forwarder as Principal
NVOCC
Road Carrier - Own
Road Carrier - Sub-Contract
Rail Carrier - Own
Rail Carrier - Sub-Contract
Air Carrier - Own
Air Carrier - Sub-Contract
Warehouse Keeper - Own
Warehouse Keeper - Sub-Contract
Others ( please specify )
 
If you are not operating under BIFA, CM, COSGA / Hague Visby, Warsaw Convention under the condition of FIATA, then you must provide a copy of the Contract / Trading Conditions for the underwriter's approval.

Please provide your turnover and volumes as follows:

Gross Freight Receipts TEU / Tons Shipped
Next 12 months
Current Year
Current Year minus one
Current Year minus two

Please provide the percentage of your traffic to / from or within the following areas:

Road Rail Cont.(sea) Cont. (not sea) Air Total
USA / Canada
Mexico
Central / South America
Middle East
Europe
Italy
C.I.S
India / Pakistan
China
Far East
Africa
Australasia
TOTAL 100%

Please mark the relevant box if you issue any of the following transport documents:
   Bill of Lading Please note, you must provide copies of the documents you issue for the underwriter's approval prior to attachment of cover.
Multimodal Transport Document
Sea Waybill
Air Waybill
Consignment Note
Freight-Forwarder's Bill

Typically, what percentage of your traffic is for the following types / categories of cargo?

Type / Category of Cargo Percentage %
Personal Effects
Wine or Beer
Spirits and other Alcoholic Beverages
Cigarettes and other Tobacco-based products
Fur and leather on garments / Items made from fur or leather
Clocks, watches and parts
Computer microchips, Hi-Fi, CD Players, etc.
Personal Computers and Games Consoles
Television
CD Players, DVD Players, CDs, DVDs, Tapes, Videos
Cellular or mobile telephones of any description
Temperature controlled cargo
Plants and / or cut flowers
Any other cargo of a high value (please specify)

Please mark the relevant box if you own or operate any of the following:
   Trailers If you own or operate any of these, FP Marine will send you a Containers and Equipment Schedule for you to complete.
Trucks / Vans
Rail Wagons
Tractor Units
Fork Lift Trucks
Cranes
Warehouses
Depots

How many staff are employed in the following categories?
Director / Senior Management Operational Senior Technical
Drivers Clerical / Secretarial Warehousemen
Others (please specify job nature and numbers employed)

Insurance Information

Please provide the following insurance information for the last four years, starting with the current year:
  Insurer Broker
Current Year
Current Year minus one
Current Year minus two
Current Year minus three

Please provide details of paid and outstanding claims for the last four years, starting with the current year:
  Paid Outstanding Total
Current Year
Current Year minus one
Current Year minus two
Current Year minus three

Please confirm the deductibles that were applicable over the last four years, starting with the current year:
  Deductible
Current Year
Current Year minus one
Current Year minus two
Current Year minus three

What deductible and limit do you require?
Deductible Limit

Please provide details of any claim which has exceeded, or is likely to exceed, USD 15,000 or GBP 10,000, or which accounts for more than 25% of the total claims in any one year.

Other Information

Please provide any further information that may be material to the insurers:

Company
Position
Date

Important Note:
The questions contained in this form are designed to give insurers information regarding your business. It may not address every aspect and it is your duty to disclose all material information to insurers that may affect the premium or conditions.