Get an Accurate Formal Quote
1. Applicants
Contact Name:
Name/s (include "Trading As" if applicable) :
Postal Address :
Postcode :
Email address :
Website address :
Business telephone no. :
Business or Occupation :
Year in business :
ABN :
List all location address/es from which you operate, including postcodes :
Other interestes parties :
Postal address/es :
Nature of Interest :
2. The Business
Please note your gross income from your business for the last financial year:
Estimated gross income for the next 12 months :
Do you engage subcontractors? : Yes No
Please indicate the amount of gross income paid to subcontractors :
Do you obtain evidence of liability insurance from subcontactors? : Yes No
Please select services and operations [X] which form part of the business and indicate percentages (where aplicable) relating thereto :
a) Logistics / supply chain operator
b) Freight forwarder
c) Non-vessel or aircraft owning carrier (NVOC)
d) Road transport oprator
e) Rail operator
f) Ship operator (coastal services)
g) Barge operator
h) Slot / space charterer
i) Multi-modal transport operator
j) Warehouse operator
k) Customs broker
l) Cargo broker
m) Shipping agent
n) Premises occupier
o) Provision of social / sports club canteen, first aid / medical / fire or ambulance services
p) Maintenance of premises
q) Car park operator
if you undertake any of the following services and operations, please select those that you wish to insure and percentages (where applicable) relating thereto. The following services are not automatically insured and may be subject to additional terms and conditions and / or payment of an additional premium.
r) Pick and pack
s) Tagging, testing, assembly and finishing
t) Inventory management
u) Long term storage
v) Advice and information
w) Landlord
x) Provision of utilities
Any other services or operations undertaken not specifically stated above, must be declared below if you wish to insure for such services and operations. Please note that any such services and operations are not automatically insured and may be subject to addition terms and conditions and / or payment of an additional premium if we agree to provide cover.
3. Operational Details
Please indicate the percentages of shipments that relate to your business:
Import
Export
Local
Please indicate the percentages in relation to the method of packaging:
Bulk
Breakbulk
Containers
Palletised
Please indicate the new percentages of shipments to or from following areas:
Australia
New Zealand
Asia
Europe
North America
Middle East
Africa
Central and South America
Please indicate the percentages of cargo represented as follows:
Dry cargoes
Perishables
Refrigerated
Project cargoes
Tank containers
Dangerous cargoes
Electronics
High value goods
Household goods
Do you handle any of the following cargoes:
Spirits
Cigarettes / tobacco
Jewellery
Work of art
Bloodstock / livestock
Precious metals
Where the value of these cargoes including duty exceeds $50,000 per shipment, please advise security arrangements in place
Do you insist that the consignor arranges insurance over the goods? Yes No
Do you operate under a customs bond? Yes No
If you operate any warehouses or packing / consolidation facilities, please provide further details:
Location
Service
Construction and age
Security
In respect of any premises, are these? Owned Leased
If leased, are you required to arrange material damage insurance in respect of the premises? Yes No
If others are occupying any part of the premises owned or leased by you, please describe their business activaties
Please describe the cargo handling equipment used by you
Please indicate the percentage of services undertaken by you as:
Principal
Agent
If acting as agent, do you also act as receiving agent on behalf of any overseas
NVOC / principal on imports? Yes No
If "Yes", do you have in place any agency agreements with such parties? Yes No
Do you have a business continuity plan? Yes No
4. Product Liability
Are you involved in any alteration, modification, addition, improvement or otherwise of any cargo handled by you, whereby you provide, supply or install any products? Yes No
If "Yes", please provide details
Do you charge your customer for such services? Yes No
Please indicate the turnover dervied by you from such sales:
If you import any of these products, please note the countries from where these products originate:
In respect of imported products, not manufactured by you, do you enforce any warranties or guarantees against the original supplier/s? Yes No
If you manufacture your own products, please provide details including who designed or formulated them
Are the finished manufactured products subject to any Australian Standards Association codes or relevant international code? Yes No
If "Yes", please provide details
Please describe the methods of quality control adopted by you
Please provide product brochures in respect of products manufactured by you
5. Contractual Relationships
Do you incorporate any of the following contractual agreements or similar into your dealings with your customers:
Please provide copies of all these agreements including any not noted below:
Standard terms and conditions
House bill of lading / air waybill
Storage agreements
Consignment note
Customer specific contracts
Standard subcontractor agreements
Have these contractual agreements been signed off or drafted by your solicitors, or are they based on standard terms published and recommended by recognised industry bodies? Yes No
Please state how you incorporate these contractual agreements into your dealings with customers / subcontractors
If you do not operate under any contractual agreements in relation to a specific service you provide, please provide us with your reasons for doing so
In respect of any products or watercraft distributed by you, but manufactured by you, do you enforce any warranties or guarantees against the original supplier? Yes No
6. Insurance
Please indicate level of cover sought:
Limit of $1m
Please indicate the excess you prefer
Policy cover for storage is limited to $100,000. If you wish to request an increase in this limit,
Please indicate amount sought
Please indicate policy limit sought for Errors and Omissions
Please indicate policy limit sought for Fines and Duty
You also have the option of insuring for optional additional cover, please indicate if you require:
Advice and information Policy limit: $1m
Costs imposed by an authority Policy limit: $50,000
Costs incurred in recovering a debt Policy limit: $50,000
Inability of ship agents to recover port disbursements Policy limit: $50,000
7. General
Please advise who your current insurer is
When does your current insurance policy expire?
If you have in place an open marine cargo policy for your customers' cargo, please provide details below
Please provide full details of all losses or claims (whether insured or not) over the last 5 years
Date of loss
Brief description
Gross amount
Status
Has any insurer at any time:
a) Declined your proposal for insurance? Yes No
b)Cancelled or refused to renew your policy? Yes No
c) Imposed special conditions / rates as a result of your policy history? Yes No
If you answered "Yes" to any of the questions above, please provide details
Are there any other relevant facts to the risk to be insured which you should disclose to enable a true assessment of your application before acceptance? Yes No
If "Yes", Please provide details
Upload your company's Standard Terms & Conditions, BOL including T&C's, & AWB including T&C's
You have read and understood the Terms & Condition
Kindly Answer for Security Reason
Incorrect value, please try again.
Correct,Thank you
