Section 1 - Your Details
Name of Insured
Address of Insured
Postcode(s) of all premises
Telephone:
Fax: 
What is your contact e-mail address?
Year Established


Section 2 - Company profile

What classes of occupation are you engaged in?
Please state number of Staff          
(a) Working Partners or Directors        
(b) Managers        
(c) Clerical        
(d) Warehousemen        
(e) Drivers        

Section 3 - Income
(a) Gross Receipts
(b) Percentage Gross Receipts          
(i)
 Road % Export    %
  Deep Sea % Import    %
  Air % Cross Trade    %
    100%     100%
           
(ii) Involving the issue of BIFA House Bills of Lading %    
(iii) Involving the Issue of Own Bills of Lading
(We will require Specimen Copies)		 %    
(iv) Involving the Issue of FIATA (F B/L's) %    
(v) Involving the Issue of CMR Consignment notes %    
(vi) Number of T Forms/SAD's requiring guarantees p.a.  
(vii) Number of CAD's/COD's undertaken p.a.  
(viii) Do you undertake business or provide services or earn income involving any other activity not described above or at 10. (Warehousing) below?  If yes give full details of all such activities and income derived there from.  
 
   


Section 4 - Marine Movements

Do you move any of the following Cargo?  
  Tobacco %   Temperature  Controlled %
  Wines & Spirits %   Hazardous %
  Hanging Garments %   Audio/Visual %
  Cars %   Personal Effects %
  Mobile Telephone %   High Value / Thief Attractive %
  Livestock %   Computer Hardware / Software %
  Perfumes %   Pharmaceutical products or controlled drugs %
  Jewellery %   Photographic equipment or film or component parts    %
  Watches %      
Does any cargo represent more than 10% of total sendings? If yes, please state nature of Cargo
 
Do movements to or from any country represent more than 10% of total turnover?  If so which, and give approximate percentage of turnover.  
 
   

Section 5 - Carriage
What conditions do you convey to your customers:
  BIFA %   RHA %
  UKWA %   OTHER %
        If other please provide a copy
Do you cite your trading conditions on all correspondence?
Do you regularly check that all sub contractors have adequate transit insurance?  
Do you use your own vehicles for the carriage of goods?
If Yes, please complete (i) to (v)    
Area of operation:  
Conditions of carriage:  
Carrying capacities:  
Income derived from this service: £  
Nature of goods carried:  
     


Section 6 - Warehousing

Do you provide your own warehousing facility?
Warehouse square footage:  
Income from this service:  £  
Conditions of storage:  
Physical protections:  
Is the facility either Bonded or ERTS?  
Does storage constitute anything other than part of the transit movement?  
           

Section 7 - Claims
Has any claim been made against the proposer or any Partner, Director, Consultant or Employee, or are you aware of any circumstances that may give rise to a claim for:
(a) neglect, error or omission in relation to professional duties?
and/or  
(b) loss or damage to goods?
If yes, please give details:  
Date
Brief details of each claim
Cost of claim
Estimated Outstanding
 

Section 8 - Insurance History
Date cover may be required    
Have you been previously insured?    
If yes, state name of the Insurer and renewal date:  
Has any application for this form of Insurance ever been declined or has such Insurance ever been cancelled or special terms imposed?
If so, please give full details:  
 
   
I/We hereby declare that the above statement and particulars are true and that I/we have not suppressed or mis-stated any material facts and I/we agree that this Declaration shall be the basis of the Contract between me/us and the Underwriters.

COMPLETING THIS FORM DOES NOT BIND THE PROPOSER TO COMPLETE THE INSURANCE