Cargo Insurance Policy Applicationadmin2021-04-25T17:29:42-05:00 1. General InformationCompany Name* Company Address* Contact Person* Phone*Email* Years in Business* No. of Employees* Policy Effective Date* DD slash MM slash YYYY Please list all associations/organizations for which your Company holds membership:2. Loss ControlDo you employ a Safety Officer or Risk Manager? Please provide name and years of experience.* 3. Company Operations & ServiceCurrent Insurance Carrier:* Please indicate the percentage per transportation conveyance commonly used by the Company (approximate):Ocean Cargo % International Air % Domestic Truck % Domestic Rail % Domestic Air % Foreign Truck/Rail % Percentage of Shipments Containerized % Percentage of Shipments in Bulk % Please indicate percentage per type of cargo (approximate):General Cargo % Electronic & Electronic Equipment % Temperature Controlled/Perishables % Machinery & Equipment % Dry Bulk % Wet Buk % Oversize Cargo % Chemicals & Hazardous Materials % Geographical ScopeUSA & Canada % China/Japan % Mexico % South East Asia % Central/South America % India/Pakistan % Europe % Middle East % Transportation and VolumeGross Freight Receipts (Total Gross Sales Less Taxes)Last 12 MonthsNext 12 Months (estimated)Shipment ValuesLast 12 MonthsNext 12 Months (estimated)WarehousingAre you looking to insure goods while in storage? Yes No Do you own or operate Warehouses for third party storage? Yes No Do you provide open storage facilities? Yes No Do you provide refrigerated storage facilities? Yes No Provide list of locations, construction, fire and security information as well as maximum values at any given time.Please indicate maximum value per shipment for:Ocean Cargo Shipments $Air Cargo Shipments $Truck/Rail Cargo Shipments $House Hold Goods Shipments $Temperature Controlled/Perishables Shipments $Electronics & Electronic Equipment Shipments $Limits and DeductiblesPlease indicate coverage limits required:Ocean Cargo Shippers Interest (All Risk) $Inland Transit Shippers Interest (All Risk) $Warehouse All Risk (Goods of Others) $Air Cargo Shippers Interest (All Risk)Please indicate deductibles per coverage:Ocean Cargo Shippers Interest (All Risk) $ Inland Transit Shippers Interest (All Risk) $ Warehouse All Risk (Goods of Others) $ Air Cargo Shippers Interest (All Risk)Please indicate preferred reporting method: Deposit Premium Adjusted Annually Monthly Reporting on Multiple Rates Loss History (5 years)Claim YearYear PremiumTotal Paid
