Marine Open Cover Enquiry Form
Click below to download: -
Marine Cargo Policy Summary
- PDF <145kb>
Please enter your details below:
NOTE:
All fields marked with a
*
must be filled in for a successful form submissions
Broker Contact Details
*
Company Name:
*
Contact Name:
*
Phone Number:
*
FSA Membership Number:
Email:
Fax Number:
UA Number if known:
*
Proposed Assured:
Address:
Year Established :
*
Telephone Number:
Fax Number
Email:
Website Address:
*
Subject Matter:
(Type of Cargo)
How is Cargo Insurance currently arranged?:
*
How are the good packed?:
e.g. Bags, Cartons,
Crated, Drums, Palleted
Who packs the goods?:
International Transits
Imports
Exports
*
Total Value:
*
Total Value:
Please provide
approx. spilt
1. Conventional/
Less than Full
Container Loads
2. Full Container/
Trailer Loads
Please provide approx. spilt
1. Conventional/
Less than Full
Container Loads
2. Full Container/
Trailer Loads
*
Seafreight:
*
Seafreight:
*
Road/Rail:
*
Road/Rail:
*
Air:
*
Air:
Origin
Destination
Please provide
approx. spilt
Ex Works
Free On Board/Cost & Freight or similar terms
Cost Insurance & Freight
Please provide approx. spilt
Ex Works
Free On Board/Cost & Freight or similar terms
Cost Insurance & Freight
*
Europe (EC):
%
%
%
*
Europe (EC):
%
%
%
*
North America:
%
%
%
*
North America:
%
%
%
*
Middle East:
%
%
%
*
Middle East:
%
%
%
*
Far East/
Australasia:
%
%
%
*
Far East/
Australasia:
%
%
%
*
Others/
Please Specify:
%
%
%
*
Others/
Please Specify:
%
%
%
*
Others/
Please Specify:
%
%
%
*
Others/
Please Specify:
%
%
%
Extensions to Cover (Imports)
Extensions to Cover (Exports)
Basis of
Valuation
EXW
FOB/CFR/
FOA/FOR
CIF
Basis of
Valuation
EXW
FOB/CFR/
FOA/FOR
CIF
Buyers
Contingency
N/A
N/A
Yes
No
Sellers
Contingency
Yes
No
Yes
No
N/A
Increased Value
N/A
N/A
Yes
No
Unpaid vendors
Yes
No
Yes
No
Yes
No
Domestic Transits
*
Total Value:
*
Road Hauliers:
%
*
Own Vehicles:
%
*
Purchases:
%
*
Sales:
%
Exhibitions
Number
Location(s)
Special Comments*
Exhibitions:
Fairs:
Demonstrations::
*Special Comments eg. Open Air, Invitation Only, Trade Only, not open to General Public
Limits of Liability
Please Advise estimated average and maximum limits for the following:
Average
Maximum
*
Per Conveyance (excluding Assured's own vehicles (see below)
Per Exhibition
Per vehicle owned or operated by the Assured (other than below)
Per vehicle in respect of engineers/sales representative
Storage
If cover is required for storage of goods other than whilst in the ordinary course of transit a supplementary questionnaire will be needed to be completed. Please ask for one to be sent to yo, In the meantime, please advise the following:
Average
Maximum
Named Location(s)
Unspecified Locations(s)
*
Has the assured suffered any losses over the past 5 years?:
Yes
No
*
If
Yes
please advise details::
Please note that this form is for enquiry purposes only. Further information may be required prior to a quotation being provided. A full PoundGates Cargo policy wording is available on request.
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