Oman Insurance Company PSC CARDHOLDER NOT PRESENT CNP CHARGE BACK INSURANCE PR

							                                                                        Oman Insurance Company PSC.
                   CARDHOLDER NOT PRESENT (CNP) CHARGE BACK
                          INSURANCE PROPOSAL FORM

     It is important to answer all of the following questions fully. If you do not have enough space then please
                                                  use a separate sheet.


                                SECTION 1 – DETAILS OF YOUR BUSINESS

1. State the name and addresses of all Companies/Firms (“Proposer”) for whom this Insurance is required:

  Proposer(s):                                                   Postal Address:



  Contact Name:                                                  E-mail Address:
  Telephone:                                                     Fax:

2. (a) Please give the website address all the sites for which you require Merchant Charge Back Insurance:

     1.http://                                             4.http://
    2. http://                                             5. http://
    3. http://                                             6. http://


   (b) What percentage of your credit card sales is over the telephone?
                                                                                                         %


   (c) What percentage of your credit card sales is via mail order?
                                                                                                         %


3. Please provide a list of the types of products sold through credit card sales via your web sites, telesales or
   mail order. Give an estimate of the turnover derived from each (use a separate sheet if necessary):

          PRODUCT                  SALES           VALUE OF GOODS SOLD             ESTIMATED VALUE OF GOODS
                                  CHANNEL            IN LAST 12 MONTHS               SOLD IN NEXT 12 MONTHS




    TOTAL CNP SALES               TOTAL TURNOVER LAST                    TOTAL CNP SALES       TOTAL TURNOVER
  LAST FINANCIAL YEAR                FINANCIAL YEAR                     THIS FINANCIAL YEAR   THIS FINANCIAL YEAR




Dubai Internet City Branch, Ph: 3911320, Fax: 3911326, Email: manoj@tameen.co.ae
                                                                         Oman Insurance Company PSC.

    4. a) Please complete the following table to reflect your sales activities:

                  No. of cardholder    Average       Largest         No. of        Total Value         Reason for Charge backs:
                    not present¹        value         Value          Charge         of Charge       (please use a separate sheet if
                  transactions via     of items    of any item       Backs:          Backs:                   necessary)
                     credit card         sold:
Last Complete
Calendar
Month:


Previous
Calendar
Month:


Last Financial
Year or period
trading:
Ending
_ _/_ _/__

    ¹: i.e. sales where the payment is made remotely by credit card (through your web sites, telesales or mail order)

    PLEASE NOTE THAT NO COVER CAN BE OFFERED FOR SALES TO THE CERTAIN TERRITORIES. PLEASE REFER
    TO FULL POLICY WORDING FOR DETAILS.


                             SECTION 2 – YOUR CREDIT CARD PAYMENT ARRANGEMENTS

    5. Please give contact details your payment processor for Internet transactions (i.e. your payment gateway):




    6. Please advise whether you use any fraud screening software:

           YES     /    NO       Type:


    7. Please give the name of the Bank providing your merchant acquiring facility:




    8. Do you collect any of the following information prior to credit card transaction authorisation:


        Cardholder Address                        YES / NO                               Authorisation Code          YES / NO
        Cardholder E-mail Address                 YES / NO                             Web site Membership           YES / NO




    9. Is there any other information that you collect to reduce the risk of fraudulent transactions?




    Dubai Internet City Branch, Ph: 3911320, Fax: 3911326, Email: manoj@tameen.co.ae
                                                                     Oman Insurance Company PSC.


10. Are there additional fraud prevention measures, which you take for goods over a certain value?

   YES/ NO                  If yes, what is the value? £__________

fraud prevention measures:




11. Do you investigate further before delivering your goods/services in any of the following circumstances:-

   There are an abnormal number of transactions with the same credit card?                           YES    / NO
   There are an abnormal number of requested deliveries to the same postcode?                        YES / NO




12. Do you deliver goods ONLY to the cardholder’s address?                    YES    /   NO


13. What delivery method(s) do you use?




14. Is a signature collected on delivery from the recipient of goods for:

    a) ALL transactions?                                              YES      /    NO



                                                                      YES      /    NO
    b) ALL transactions over £500?



15. Is sight of the credit card insisted on at delivery?              YES      /    NO



                                                        DECLARATION


I/we declare that the statements and particulars given above are true and that I/we have not mis-stated or
suppressed any material fact. I/we agree that this Proposal Form, together with any other material information
supplied by me/us shall form the basis of any contract of insurance effected thereon.

I/we undertake to inform Underwriters of any material alteration to these facts occurring before the completion of
the contract.


     Dated:                                                   Signed:

                                            Position held at Proposer:




Dubai Internet City Branch, Ph: 3911320, Fax: 3911326, Email: manoj@tameen.co.ae