freight forwarders liability questionnaire

Please complete this questionnaire to apply for Freight Forwarders Liability Insurance.
YOUR CONTACT DETAILS
Your Name
Contact Phone Number
Fax Number
Website Address
Email Address
Postal Address
PROPOSER'S DETAILS
Proposer's full name
Proposer's postal address
Proposer's operational address
Services and activities provided
PERIOD, LIMIT AND DEDUCTIBLE
Cover requested from as of 4.00pm
Limit of liability required
Preferred Deductible
SERVICES AND ACTIVITIES PROVIDED
Are you a Freight Forwarding Agent?
Do you package and label your cargo?
Do you consolidate your cargo into containers?
Do you transport cargo in your own vehicles?
Do you transport cargo in subcontractor's vehicles?
Are you a non vessel owning carrier?
Are you a carrier by air?
Do you lease/hire/own containers/trailers/handling equipment?
Do you store cargo in warehouse(s) owned/leased/operated by you?
Do you store cargo in bond store(s) owned/leased/operated by you?
Do you provide customs clearance for imported cargo?
Are you the agent for consignees or overseas principals for imported cargo?
Are you a Marine Insurance agent?
PLEASE SUPPLY THE FOLLOWING DOCUMENTS
Please supply a copy of your Standard Trading Conditions and Bills of lading, Airway bills, Waybills, Consignment Notes, Agency Agreements and ANY OTHER contractual agreements for services and activities you have marked YES above and for which insurance cover is required.

CARGO VOLUMES
Do you handle Project or Specialised cargo?   Volume: 
Do you handle High Value cargo?   Volume: 
Do you handle Refrigerated cargo?   Volume: 
Do you handle Tanktainer cargo?   Volume: 
TYPE OF COVER REQUIRED
Associated Marine Insurers through Midas Insurance Brokers provides cover against these liabilities including the associated legal costs with six cover options available to provide the level of cover you require.

Basic Risks Covered

According to the cover options, chosen cover includes:

Cover Option 1: Liability for non-contractual liabilities at law and specified legally enforceable contracts, including consequential losses, arising out of the provision of insured services.



Cover Option 2: Liability for loss of or damage to cargo and consequential loss arising therefrom under contracts of carriage, international conventions or law.



Cover Option 3: Liability for errors or omissions in providing insured services or resulting from delay and indemnity for financial penalties imposed by authorities.



Cover Option 4: Indemnity for costs and expenses arising out of an occurrence which may give rise to a claim covered by any applicable cover option, arising out of the provision of insured services.



Cover Option 5: Liability for removal and disposal of an abandoned cargo, payments due under standard forms of customs bonds or guarantees, statutory enactments imposing the responsibility of a principal, fraudulent or dishonest acts of employees and costs of recovering monies due.



Cover Option 6: Loss of or damage to specified equipment including liability to pay general average or salvage charges or lease per diem charges in respect of lost or damaged equipment.


If you have chosen Option 6, please list the equipment to be insured. Include descriptions, serial numbers and values.
FINANCIAL DETAILS
State ANNUAL GROSS RECEIPTS (Freight Forwarder) and/or ANNUAL GROSS INCOME (Customs Broker) in respect to services/activities to be insured.
1. Freight Forwarder 2. Customs Broker
A. Estimated for 12 months prior to the period to be insured $  $ 
B. Actually earned for the last completed 12 month period $  $ 
C. Estimated for the period to be insured $  $ 

Breakdown of C.1 (above) in estimated percentages
A. When acting as a Principal Carrier as an NVOC issuing your own bill of lading % 
Also please advise:

Estimated Annual TEU

Main destinations served
B. When acting on behalf of customers arranging transportation as an agent
By Sea (%) By Air (%) By Road (%)
C. When providing other services % 
(Total of percentages in a. b. and c. must add to 100%)

Breakdown of C.2 (above) in estimated percentages
a. When acting as a Customs Broker % 
b. Other - please specify % 
(Total of percentages in a. and b. must add to 100%)
PRIOR HISTORY (LAST 5 YEARS)
Name of present insurer
If any insurer has declined your insurance or imposed special terms in the past, please list the details
Detail your claim record for the last 5 years (include incident reports and claims not paid)


Enter Validation Code
LAW

The insurance if accepted will be subject to Australian law and may be subject to the provisions of the Marine Insurance Act 1909 or the provisions of the Insurance Contracts Act 1984.

If this proposal form is completed in whole or in part by any person other than the proposer then such person shall be deemed to be the agent of the proposer and not the agent of Associated Marine Insurers Agents Pty Ltd.

The proposer who completes this proposal form has their attention drawn to the terms of Section 23 to 27 of the Marine Insurance Act 1909 and in particular is informed that the contract of marine insurance that may be made and which may have as its basis the material contained herein, is a contract based upon the utmost good faith and the absence of such good faith may be avoided. Further, the proposer is informed that there is an obligation to disclose to the insurer every material circumstance which is known to the proposed insured and/or which in the ordinary course of business ought to be known to the proposed insured. Every circumstance is material if it would influence the judgement of a prudent insurer in fixing the premium or determining whether they will take the risk. If there is a failure to make such disclosure the insurer may avoid any contract of insurance that may be made.


DUTY OF DISCLOSURE

Before you enter into a contract of general insurance with the insurer you have a duty under the Insurance Contracts Act 1984 to disclose to the insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer's decision whether to accept the risk of the insurance and if so on what terms. You have the same duty to disclose those matters to the insurer before you renew, extend, vary or reinstate a contract of general insurance. Your duty does not require disclosure of matter

  • that diminishes the risk to be undertaken by the insurer
  • that is common knowledge
  • that the insurer knows, or in the ordinary course of its business, ought to know
  • as to which compliance with your duty is waived by the insurer.

NON-DISCLOSURE

If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability under the contract in respect of a claim or may cancel the contract. If you non-disclosure is fraudulent the insurer may also have the option of avoiding the contract from its beginning.


FREIGHT FORWARDER'S LIABILITY - INFORMATION YOU WILL WANT TO KNOW ABOUT THIS INSURANCE

THE POLICY

Freight Forwarders are potentially exposed to a wide variety of liabilities in respect to the services they provide. These include liabilities to third parties: loss of or damage to cargo, errors and omissions, removal of abandoned cargo, breach of authorities; regulations and loss of or damage to owned or leased equipment.


PRINCIPAL RISKS EXCLUDED

  • This insurance does not cover liability, loss damage, or expense in respect of the following
  • Where more specific insurance exists
  • Punitive or exemplary damages
  • Insolvency or financial default of the insured
  • Operation or management of a ship or aircraft
  • Time penalties
  • Dredging operation or dumping site or disposal of waste
  • Waive of rights of recourse

PREMIUM

This is based on your gross receipts or gross income for the period of insurance, the limit of liability, your contractual arrangements, services provided and cover options chosen. A minimum and deposit premium is calculated on your estimated gross receipts/gross income and this is adjustable on expiry of the policy period on gross receipts/gross income if these are higher than estimated.


SETTING YOUR CLAIM

Subject to the policy deductible our experienced claims staff will promptly indemnify you up to the agreed limit for legal liability and costs insured by the policy.


IMPORTANT

The information above is an outline of the cover provided. Full details of the cover with all limitations exclusions and conditions are in the policy.


DECLARATION

I/We authorize Associated Marine Insurers Agents Pty Ltd to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service.

I/We hereby declare that to the best of our knowledge and belief
  • 1. the information provided herein is true and correct in every respect and I/we have not withheld any material information
  • 2. the sums proposed for insurance represent the full value
  • 3. I/we have received the proposal/information sheet and agree to accept the insurance subject to the terms, conditions, exclusions and limitations of the policy.