Terminal Operators' Questionnaire Form
Company Information
Operational Information
Please provide details of the terminal to be insured.
For any additional terminals, please fill in separate questionnaires as required:
Please provide details of the services you provide (or are provided by sub-contractors) at the location listed above:
Please provide details of how you contract and the type of liability you assume with customers and other users of the terminal:
If the above table does not clearly show how you contract or assume liability, please provide further details:
Have you provided any indemnities or waived rights of recourse against any parties?
Yes
No
Please provide the annual throughput of cargoes handled
Please provide the following financial information
Please provide an estimate of the number of vessels handled by you during the last 12 months:
Please provide an estimate of the size of vessels handled during the last 12 months:
Insurance History
Please provide details of your insurers and brokers over the last four years:
Please provide details of paid and outstanding claims for the last four years:
Please provide details of any claim that has exceeded, or is likely to exceed, USD25,000, or which accounts for more than 25% of the total claims in any one year.
Please confirm the deductibles that were applicable over the last four years:
What deductible and limit do you require?
Other Information
Please provide any further information that may be material to the insurers:
I confirm that this form has been completed accurately and that all material information has been given. Completion of this form is not binding by either party.