Ports and Terminals by hedongchenchen

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									                   PORTS, TERMINALS & DEPOTS Proposal Form
1. GENERAL INFORMATION:

 Company Name:


 Address:




 E-mail:                                                    Vat No:
 Date Company Established:

 Insurance Broker to whom Quotation should be sent:




 Subsidiary Companies to be named in the insurance policy:
 .
 .
 .
 .



 Directors and Senior Managers (Please give names and qualifications):

 .

 .

 .

 .




2. ACTIVITIES:

       Full Circle is the Intermodal and Marine Professional Indemnity divsion of Oceanic & Industrial Consulting Ltd.
     Registered in England No. 3549873. Authorised and Regulated by The Financial Services Authority - Reg No. 308510
                 PORTS, TERMINALS & DEPOTS Proposal Form

                                                                                           Tick as applicable
Marine Facilities
Stevedoring
Container Terminal
Roll On - Roll Off Berths
Car Terminal
Fruit Terminal
General Cargo Facilities
Dry Bulk Terminal
Oil and Gas Terminal
Other Wet Bulk Facilities
Cruise/Passenger Terminal
Livestock Facilities
ICD/CFS
Intermodal Rail Depot
Container /Trailer Storage and Repair Depot
Refrigerated Warehouse
Districentre
Warehouse or Depot
Airfreight Distribution Centre
Others (Please attach further details)

3. OTHER SERVICES PROVIDED:
                                                                                              Yes            No
Local Delivery and Collection
Long distance Delivery (over 70km)
Leasing Company Depot
Trailer/Chassis Pool
Freight Forwarding
Ship agency
Tank Container Cleaning
Waste Disposal
Ship's Garbage Removal

4. OPERATIONAL INFORMATION
    Full Circle is the Intermodal and Marine Professional Indemnity divsion of Oceanic & Industrial Consulting Ltd.
  Registered in England No. 3549873. Authorised and Regulated by The Financial Services Authority - Reg No. 308510
                 PORTS, TERMINALS & DEPOTS Proposal Form
(Please indicate the amounts moved)

                                         Last Year                 This Year Estimated       Next Year Forecasted
 Loaded TEUs
 Empty TEUs
 Reefer/Tank Units
 Breakbulk Tonnes
 Refrigerated Breakbulk Tonnes
 Wet Bulk Tonnes
 Dry Bulk Tonnes
 Cars (number)
 Air Freight (kgs)
 Passenger (pax)
 Livestock (heads)
 Other (Please give details below)

5. GARBAGE DISPOSAL
If you dispose of a Ship’s garbage, please tick the applicable route(s) and method(s):

 Route:

         Via a specialist subcontractor
         Municipal Collection
         Own Disposal
         Port Authority

 Method:

         Incineration
         Landfill
         Other (please attach details)


6. EMPLOYEE INFORMATION
(Please tick the category of workers handling cargo)

         Direct Employees
         Port Labour Pool Hire
         Employed by an Independent Company




     Full Circle is the Intermodal and Marine Professional Indemnity divsion of Oceanic & Industrial Consulting Ltd.
   Registered in England No. 3549873. Authorised and Regulated by The Financial Services Authority - Reg No. 308510
                 PORTS, TERMINALS & DEPOTS Proposal Form
7. CUSTOMER CONTRACT INFORMATION
(Please tick the correct kind of contracts with customers)

         Standard Contracts
         Individual Under Agreements
         Port Tariffs or By Laws
         Other (please attach details)

Liability under these Contracts (Please tick the standard of liability):
         Limited Liability in Negligence
         No Liability
         Unlimited Liability in Negligence
         Other (please specify below)




Indemnity and Rights of Recourse Information:
                                                                                                 Yes            No
 Are any indemnities in force for negligence
 Are any rights of recourse waived

8. EQUIPMENT AND PROPERTY INFORMATION:

 ( i ) Equipment Insurance:        please provide us with the aggregate value of the equipment to be
insured and attach a separate schedule showing each item, its age, value and whether it is owned or
leased:

                   Aggregate Value:




 ( ii ) Property Insurance:         please provide us with the aggregate value of the building and
structures to be insured and attach a separate schedule showing each item, its age, value and whether it
is owned or leased:

                    Aggregate Value:


( iii ) Warehousing and Depot:        please provide us with a separate schedule indicating (a) size in
square meters and (b) fire and security precautions in place.




     Full Circle is the Intermodal and Marine Professional Indemnity divsion of Oceanic & Industrial Consulting Ltd.
   Registered in England No. 3549873. Authorised and Regulated by The Financial Services Authority - Reg No. 308510
                 PORTS, TERMINALS & DEPOTS Proposal Form

9. CLAIMS HISTORY
Have any claims been made against the company or present
partners or directors in respect of the type of liabilities to which                                      Yes         No
to which this proposal relates?

(If yes, please attach full details)


Have you, at any time, been refused similar insurance, or been                                            Yes         No
quoted increased premiums or had special terms imposed?
(If yes, please attach full details)



10. CURRENT INSURANCE
please provide us with the following details:
(a) Name of insurer:
(b) Limit(s) of liability:
(c) Deductible(s):
(d) Premium:



11. COVERAGE REQUIRED:
                                               Currency                 Limit of Liability                      Deductible
Physical Loss of
or Damage to Cargo:

E&O:

Third Party Property Damage
(exc. Cargo) Death, Bodily Injury:

Fines, Duty and Penalties:




    Full Circle is the Intermodal and Marine Professional Indemnity divsion of Oceanic & Industrial Consulting Ltd.
  Registered in England No. 3549873. Authorised and Regulated by The Financial Services Authority - Reg No. 308510
                 PORTS, TERMINALS & DEPOTS Proposal Form
12. DECLARATION

The applicant declares that the information given in this proposal form are true to the best of his or her
knowledge or belief and no facts which may influence the assessment of the risk have been misstated or
suppressed. If a contract of insurance is agreed, the applicant understands that the information given in
this proposal will form part of the contract.

     Name:………………………………………….                                              Position:……………………………………….



     Signature:……………………………………..                                          Date:……………………………………………


                                 Please return the completed proposal form to:

                                          FULL CIRCLE UNDERWRITING
                                                  24 Lime Street,
                                                London, EC3M 7HS
                                          Tel:     + 44 (0) 207 1000 823
                                        E-mail: general@fullcircleuw.com




     Full Circle is the Intermodal and Marine Professional Indemnity divsion of Oceanic & Industrial Consulting Ltd.
   Registered in England No. 3549873. Authorised and Regulated by The Financial Services Authority - Reg No. 308510

								
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