Allianz Global Corporate & Specialty

Transcription

1 Allianz Global Corporate & Specialty APPLICATION FOR OPEN CARGO INSURANCE Applicant Name Address Web Site Contact Name Telephone_ Fax Title Description of Goods to be Insured Any shipments of goods not moving under an Invoiced value? If yes, describe: Any shipments of used or reconditioned goods? If yes, describe: Average Terms Requested for International Shipments please check coverages requested All Risk, "With Average"_, FPA", Bulk Liquid Clauses _, Refrigerated Goods Clauses, Other, please specify : Limits of Insurance Requested International Shipments Values per Shipment Average Maximim Vessel_ Aircraft_ Barge Mail/ Parcel Post Courier (FedEx, DHL etc) _ Rail Truck Page 1 of 6

2 Geographic Distribution of Shipments (At "By", please show Vessel, Aircraft, Mail, Courier, Truck or Rail) Show details of non U.S. domestic transits if you are responsible for these or require ContingencyCoverage for them Estimated Annual Shipment Values Origin Destination By Last 12 months Upcoming 12 months Note: Shipments to/from countries of the former USSR are insured under reduced coverage. If you have or contemplate having shipments to the countries of the former USSR, please give complete details on an attachment to this application. Logistics Operations: Do you have property in the care, custody or control of third party logistics/supply chain operators either at your locations or otherwise? _ Are these goods to be insured hereunder? If yes, please supply details of locations used and operations performed, and the operator s liability under their contracts or at law for damage to your goods: Carrier Information: Vessel Lines Used _ Airlines Used_ Product Packaging: Please indicate % of shipments packed in following: Export Strength Multiwall cartons Open Side Wood Crates Solid Sided Wood Cases Fiber Drums Steel Drums Other (e.g. pallets, skids, please describe Inter-Modal Container Useage Refrigerated? No Yes Temp_ Percentage of shipments in containers Values per container Average Maximum_ Who loads/ unloads containers? Description of container seals/ security If shipped in other than standard dry cargo intermodal containers, please describe containers used and percentage of annual containter useage in other types of containers such as flat racks, open tops, etc.: Property shipped on deck (Details e.g. description; how secured; who supervises loading, etc.) Page 2 of 6

3 Valuation Invoice Value, including any prepaid and/ or guaranteed and/ or advanced freight, plus 10%; or other % Assured's selling price, less unincurred expenses. In the absence of an invoice, goods to be valued at the actual cash value at destination on the date of shipment, less any charges saved which would have become payable upon delivery at destination. Additional Coverage Requested U.S. Import Duty Contingency Insurance for Unpaid Vendor (goods sold by Applicant on terms not requiring them to provide insurance). Estimated annual value of such shipments: Contingency Insurance for Assured as Consignee (goods purchased by Applicant on terms not requiring them to provide insurance). Estimated annual value of such shipments: Difference in Conditions (perils not covered by other insurance but which you request to be covered under this policy). Estimated annual value of such shipments: Details of other insurance coverage: Increased Value (any difference between the value insured by other insurance and the value in accordance with the applicable valuation clause of this policy). Estimated annual value of such shipments: Details of other insurance coverage: Guarantee of Collectability (if the Applicant cannot collect under other insurance for loss or damage from perils covered under this policy, this Company to advance, as a loan, the amount of loss as provided in this policy. Such loss to be repayable upon remittance of any sum due from other insurance). Estimated annual value of such shipments: Details of other insurance coverage: FOB, FAS, C&F,etc SALES (export shipments sold by Applicant on FOB, FAS, C&F or similar terms of sale, which do not obligate them to provide insurance for the overseas movement. Estimated annual value of such shipments: Details of other insurance coverage: Strikes, Riots & Civil Commotion (SR&CC) War Risks (applicable to overseas shipments only except to areas "on application") TRIA Terrorism Coverage Page 3 of 6

4 Domestic (USA) Transit Shipments Shipments originating and terminating wholly within the 48 contiguous States of the United States, except for waterborne shipments. Geographic Distribution of Shipments (At By, please show Your Vehicles, Truck Lines, aircraft, mail, Courier,) Estimated Annual Shipment Values Origin Destination By Last 12 months Upcoming 12 months Product Packaging: Please indicate % of shipments packed in following: Domestic Strength Multiwall Cartons Export Strength Multiwall cartons Open Side Wood Crates Solid Sided Wood Cases Fiber Drums Steel Drums Other (e.g. pallets, skids, please describe Limits Requested Values per Shipment Average Maximum Truck_ Rail Air Mail/ Parcel Courier (Fed Ex, DHL etc) For shipments other than Mail/Parcel and Courier: Percentage of shipments under full value bill of lading Percentage of shipments under released value bill of lading If liability released, to what amount? Certificates of insurance obtained from truck carriers? Yes_ No_ Limit of insurance required of carriers For Courier Shipments: What percentage of Courier shipments allow the following: Saturday Delivery, Non Signature Delivery ( Drop Shipments ) _, Increased Carrier Liability from Standard $50 per shipment for DHL and FedEX. or $100 per shipment for UPS Page 4 of 6

5 Storage Coverage (U.S. or Overseas Storage) For each location, please complete the attached Building Checklist if such information is available; if not available, please fax copies of this listing to each warehousemen for completion and request it be returned to you. Address/ Location Average Values Max Values Limit Requested 1. $ $ $ 2. $ $ $ 3. $ $ $ 4. $ $ $ 5. $ $ $ Does Applicant need coverage for: Goods on Exhibition_, Goods at Processors Locations _ Does applicant now have an Open Cargo Policy? General Information No how insured? _ Yes insurer names/ dates Does the Applicant need to issue Certificates/ Special Policies? NoYes_ Annual Number Does Applicant have Internet access and would they like to issue Certificates on line via our Internet based FOCUS system?_ Losses Last 5 Years (whether or not covered by insurance insurer loss documentation required to bind). Date Amount Paid Details Loss Payees Page 5 of 6

6 Premium/Reporting Format Requested Does Insured prefer: For transit coverage Reporting per individual shipment and rating of policy against specific shipments/destinations Reporting of values shipped by quarter/ half year/full year, and rate against gross sales (average rate will necessarily be slightly higher on some shipments and lower on others versus individual shipment rating) with quarterly/ biannual/ yearly up front deposits For Storage Coverage: Reporting of values at the end of the month at each warehouse, with rating against each location Premium against limits of liability at each location with no reporting of values ( policy will be subject to 100% coinsurance clause at each location) Additional Information/ Comments Application completed by Signature/ Title Date Page 6 of 6