Marine Cargo InsuranceProposal Form

Company data

Policy holder - who will be policy holder?

Name of company ……..................................................................................................

……..................................................................................................

Address ……..................................................................................................

Post code / Town .........................................................................................................

Contact person .........................................................................................................

Phone .........................................................................................................

Telefax .........................................................................................................

Insureds - which other branch offices and/or companies need to be insured?

Name Country / Town

.........................................................................................................E-Mail

Homepage .........................................................................................................

............................................................ ............................................................

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

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Marine Cargo InsuranceProposal Form

Business information

Core business

Production of and trading with

.........................................................................................................................................................................

.........................................................................................................................................................................

trading only with

.........................................................................................................................................................................

.........................................................................................................................................................................

others

.........................................................................................................................................................................

Ancillary activities yes / no

.........................................................................................................................................................................

.........................................................................................................................................................................

trading only with

.........................................................................................................................................................................

.........................................................................................................................................................................

others

.........................................................................................................................................................................

Remarks

Production of and trading with

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Kind of goods

Which kind of goods is to be insured - please indicate particularities:

Packing BUYING IN % SELLING IN %

Cartons

Cartons on pallets

Cases

Crates

Casks / Barrels

Small casks

without packing

Container - Goods in packing

Container - Goods in crates

Container - Goods without packing

Who does the packing for sendings/exports?

the insured yes no

a professional packer

Is multiple use packing being used

If YES, which type? ………………………........................................................................................................

yes no

yes no

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Buying - what is being imported and wherefrom?

KIND OF GOODS COUNTRY YEARLY VOLUME INCHF

INCOTERMS / % 1)

Raw material:

Semi-finished products:

Finished products:

Means of production: - e.g. machinery for own use etc.

1)Please indicate chosen Incoterms with percentage

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Selling - what is being exported and whereto:

KIND OF PRODUCT COUNTRY YEARLY TURNOVER INCHF

INCOTERMS / %

Remarks:

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Means of transport - which method is being used?

MEANS OF TRANSPORT BUYING/IMPORTS IN SENDINGS/EXPORTSIN %

INLAND TRANSIT IN %

Rail

Lorry (Carrier)

Lorry (own)

Air

Vessel (inland waterways)

Vessel (high seas)

Parcel service

Post

...................................... pieces

...................................... pieces

...................................... pieces

……………………................ %

average value CHF .................................................

maximum value CHF .................................................

Additional information for parcel services (e.g. DHL, UPS, DPD etc.)

...................................... pieces

...................................... pieces

...................................... pieces

average value CHF .................................................

maximum valuet CHF .................................................

Which parcel service(s) are used?

............................................................................................................................................................

............................................................................................................................................................

……………………………………………………………………………………………………………….....

%

How many are registered inland?

How many parcels are sent per year?

How many parcels are sent per year?

Thereof inland?

Thereof abroad?

Values per post parcel:

Additional information for post

Values per post parcel:

Thereof abroad?

Thereof inland?

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Handling of transportation/shipping

own organisation share ............................................................%

Forwarders/carriers - first addresses share ............................................................%

Low cost forwarders/carriers share ............................................................%

Parcel service(s) share ............................................................%

Are there heavy lift shipments? yes no

Are individual pieces sent as heavy lift?

Own means of transport

Are there regular transports with own means, e.g. lorries?

If YES, please indicate

TYPE OF VEHICLE NUMBER OF VEHICLES VALUES PER SHIPMENT IN CHF

noyes

noyes

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Permanent storages (distribution storages), i.e. storages indipendent of a transport

PLACE / STORAGE HOLDER AVERAGE SUM INSURED MAXIMUM VALUE STORED

Storages at manufacturers or forwarders

PLACE / NAME OFMANUFACTURER ORFORWARDER

AVERAGE SUM INSURED MAXIMUM VALUE STORED

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Requested insurance - Scope of insurance

Restricted insurance as per art. 2 GCMI 2006 covering loss anddamage when they are the direct consequence of a so-calledspecified accident plus theft and disappearance of entirepackages or of whole consignments yes no

Insurance against all risks as per art. 4 GCMI 2006

Both forms cover loading, transhipment and discharge.

Place to place (Standort/Standort)

Chipping, scratching, grazing or chafing

Additional repair costs

Debris removal costs

Customs and excise duty

War

Mines

Strikes, disturbances, terrorism

Exports protection clause

Subsidiary insurance on imports

Difference in condition / Difference in limits (DIC/DIL)

On deck shipments

30 days intermediate storage

60 days intermediate storage

……………………………………………………………………………

……………………………………………………………………………

……………………………………………………………………………

……………………………………………………………………………

noyes

noyes

noyes

noyes

noyes

noyes

noyes

noyes

noyes

noyes

yes no

noyes

yes no

noyes

noyes

yes no

noyes

yes no

noyes

Forms of cover

Extensions of cover - which of the following extensions is needed?

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Which sums insured per means of transport are needed?

MEANS OF TRANSPORT MAXIMUM SUM INSURED IN CHF

Lorry (Carrier), trailer included

Lorry (own), trailer included

Rail

Air

Vessel (inland waterways)

Vessel (high seas)

Postparcel

Parcel service, per parcel

Accumulation of goods in the same port, airport,postal office, railway station or any otherlocation

Requested insurance - Deductibles / franchises

Is a deductible/franchise wanted?

If YES, which type?

Deductible 1)

If YES, which amount? CHF ...........................................................

Franchise 2)

If YES, which amount? CHF ...........................................................

1) The chosen amount is deducted from the indemnity in all cases.

2) Damages upto the chosen amount will not be indemnified. Damages above the chosenamount will be indemnified in full.

noyes

noyes

noyes

Requested insurance - Sums insured

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Requested insurance - Various

Fairs/Exhibitions

Is cover for fairs/exhibitions needed?

If YES, please indicate the respective events:

FAIR/EXHIBITION COUNTRYTOWN

DURATION SUM INSUREDNEEDED IN CHF

Is cover for fairs/exhibitions needed?

If YES, please indicate the respective events: CHF ........................................................

noyes

yes no

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Manipulations (internal movements)

Is cover for manipulations needed?

If YES:

Which amount per movement is needed? CHF.............................................

Which means of manipulation are used?

Fixed cranes

Moving cranes

Hydraulic lift

Block and tackle

Conveyor belt

Manual pallet lift

Fork lift

Trolley

...........................................................................................

...........................................................................................

...........................................................................................

yes no

noyes

noyes

yes no

noyes

yes no

noyes

yes no

noyes

yes no

noyes

yes no

noyes

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Luggage insurance

Is cover for luggage of staff on business travels needed?

If YES:

How many staff travel regularly? Number of staff .................................

How long do these journeys last as a rule? Days ............................................

Where do the staff travel to?SwitzerlandEuropeNorth AmericaSouth AmericaAfricaAsiaAustralia

What is the value of the luggage?CHF 3'000CHF 5'000CHF 10'000…………….

Should the luggage insurance include cover for?WatchesJewelleryComputers…………..

noyes

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48

Marine Cargo InsuranceProposal Form

Business equipment on journeys

Is cover for equipment on business travelsneeded?If YES:

How many staff do take business equipmenton their travels?

Number of staff ...................................................

How long do these journeys last as a rule? Days ......... ...............................................................

Where do the staff travel to?SwitzerlandEuropeNorth AmericaSouth AmericaAfricaAsiaAustralia

CHF...........................................................................

What type of equipment is to be insured?

Is such equipment taken in cars/vans?

If YES, how many cars/vans are used? Number of vehicles ...............................................

noyes

noyes

What is the value of the equipment taken ontravels?

HDI Global SEDufourstrasse 46, Postfach8034 ZürichTel: +41 44 265 47 47Fax: +41 44 265 47 48