PoundGates Insurance¸ Claims & Risk Management Solutions

FreightGuard Questionnaire

Click below to download: -
FreightGuard Policy Summary - PDF <150kb>

Please enter your details below:
NOTE: All fields marked with a * must be filled in for a successful form submission.

Broker Contact Details
*Company Name:
*Contact Name:
*Phone Number:
*FSA Membership Number:
Email:
Fax Number:
UA Number if known:
General Information
*Name of Assured:
Address:
Telephone Number:
Fax Number:
Website:
*Year Established:
Geographical Limit:
*Expiry of Current Policy:

*Does the company work with sub-contractors?	Yes No
If Yes what proportion is carried by:
*a) Your own vehicles or vehicles under your control?		%
*b) Sub-Contractors?		%
c) Do you require them to accept the same level of liability as you and obtain written confirmation?	Yes No
d) Do you ask about their conditions of trading and ensure they are acceptable?	Yes No
e) Do you obtain written confirmation that they have valid and adequate insurance?	Yes No

Type of Goods Carried
In respect of Transportation and/or storage undertaken by yourselves:
a) What type of goods are normally involved?

b) Do you ever carry/store or anticipate carrying/storing bullion and precious metal objects, bank notes, coins, cheque's, credit cards, bonds, negotiable documents, securities and other financial instruments, jewellery, works of art, antiques or precious stones except where part of household/personal effects cargo, live animals, birds, reptiles and fish, mobile phones, SIM cards, computer chips computers and game consoles, radioactive, nuclear or biological material, live vaccines?

Yes No

If Yes provide details:

Trade Association
Are you a member of any trade associations?	Yes No
If Yes provide details:

Background Information
In order for us to provide a competitive quotation please provide any background information you think will be of benefit and other material facts:

If Yes please list special contracts, turnover and financial limit, copies will need to be supplied except those which are standard trading condition's with uplifted limits:

Name of Contract	Turnover	Financial Limit
	£	£
	£	£
	£	£
	£	£

Please provide the total turnover during the last 5 years

Current Year	£
Current Year Minus One	£
Current Year Minus Two	£
Current Year Minus Three	£
Next 12 Months (Estimation)	£

Please advise the percentages of travel to/from or within the following areas:

Geographical Area	Sea (%)	Air(%)	Road(%)
UK	%	%	%
Europe	%	%	%
CIS	%	%	%
Eastern Europe excl. CIS	%	%	%
USA	%	%	%
Middle East	%	%	%
Far East/Australia	%	%	%
Other	%	%	%

Please advise the percentages of your traffic for the following types/categories of cargo:

Cargo Type		Cargo Type
Wines, bottled spirits and other alcoholic beverages	%	Cigarettes and other tobacco based products	%
Fur and leather garments or items made from fur or leather	%	Footwear, clothing, bottled perfumery and cosmetics	%
Televisions, cd players, dvd players, tapes, videos and other domestic audio and/or visual equipment or accessories	%	Non-ferrous metals in scrap, sheet, bar, tube, ingot or similar form	%
Photographic equipment or accessories	%	Clocks, watches and parts	%
Razor blades	%	High value food items where cargo value exceeds ukp100,00	%

*Please provide details of current limit and deductible for each operation covered:

	Current Limit	Current Deductible
*Freight Forwarder	£	£
*Nvocc (non-vessel operating common carrier)	£	£
*Road haulage	£	£
*Other (please specify)	£	£
*Warehousekeepers	£	£
*Errors & omissions	£	£
*Third party liability	£	£
*Transport equipment (container/trailer coverage)	£	£

Transport Equipment, if applicable

Is the equipment owned or leased?	Owned Leased Both
Do you require physical loss or third party cover?
Physical loss:	Yes No
Third party cover?	Yes No
Please provide breakdown of equipment i.e value and type::

Warehousing

Locations:
Please list all warehouses together with their addresses, with average and maximum tonnes left in store

Trading Conditions:
Do you have any special contacts with customers

Yes No

Security Arrangements - Please detail the company's safety precautions regarding:
Age of buildings:
Perimeter Fencing:	Yes No
Security Alarms:	Yes No
CCTV:	Yes No
Perimeter Fencing:	Yes No

Construction Material (wood, concrete, brick, iron, other) for:
Walls:
Floor:
Roof:
Guards:	Yes No
If Yes, detail whether this is 24 hours or outside business hours only. If the latter, are they on site of car patrols?
Is there access to warehouse/depots for third parties:	Yes No
Are working conditions and procedures compliant with health and safety regulations:	Yes No

Fire Precautions

Claims History

*Please provide detail of paid and outstanding claims for the last 5 years with deductible that applied:

	Paid	O/s	Total	Deductible
*Current Year
*Minus 1
*Minus 2
*Minus 3
*Minus 4

*Has the company had any losses and/or claims which exceed or are likely to exceed usd25,000 or which compromises more than 25% of the total claims in any one year:

Yes No

*If Yes please complete below schedule:

	Paid	O/s	Total	Deductible
*Current Year
*Minus 1
*Minus 2
*Minus 3
*Minus 4

Please provide details of your insurers and brokers over the past 4 years:

	Broker	Insurer
Current Year
Minus 1
Minus 2
Minus 3
Minus 4

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.