PROPOSAL FORM: FREIGHT FORWARDER LIABILITY

Transcription

1 PROPOSAL FORM: FREIGHT FORWARDER LIABILITY Name of Proposer Proposer Address Website Address Years of Formation Inception Date Expiry Date Number of Employees Full Time Part Time Directors / Officers / Partners Is your company a member of the Federation of National Forwarders Association Is your company an IATA Agent Limit of Liability RM Please provide latest Report/Account and any brochure describing services provided. EXISTING INSURANCES Do you currently have insurance for Cargo Liabilities Professional Negligence (Errors & Omissions) Third Party Liabilities Customs Liabilities Have you ever been refused / cancelled for any insurances mentioned above Do you have an open cover for the sale of marine cargo insurance to your customers If yes, what percentage of your cargo is insured through your open cover CLAIMS HISTORY Please provide the number and total amount of all paid and pending claims made against you (whether you have been insured or not) during the current and past five years, in respect of your freight forwarding operations. Please attach the details of any single claim (paid or pending / estimated) which represents more than 50% of premium paid in the year of claim occurred YEAR 5 years ago 4 years ago 3 years ago 2 years ago 1 years ago Current year TOTAL PREMIUM CLAIMS PAID CLAIMS PENDING / ESTIMATED NUMBER AMOUNT NUMBER AMOUNT Page 1

2 Sea Air Road Rail TRAFFIC Warehousing Customs Brokerage Other TOTAL THROUGHPUTS VOLUMES AND PARTICULARS OF TRADE Please provide the volume of trade CURRENT YEAR GROSS FREIGHT RECEIPT (RM) Gross Freight Receipts include disbursements but excluding duty Throughput please indicate for units ie TEUs, metric tons, CBM Others please provide details NEXT YEAR (ESTIMATE) THROUGHPUTS GROSS FREIGHT RECEIPT (RM) PARTICULARS Sea Air Road Rail Other TRAFFIC AS PRINCIPAL (%) For the applicable traffic AS AGENT (%) - Principal and Agent add up to be 100% - Port to port and door to door add up to be 100% - FCL and LCL add up to be 100% PORT TO PORT (%) DOOR TO DOOR (%) FCL (%) LCL (%) TRADING AREA Please provide the percentage of each traffic for each trading area Traffic / Trading Area Sea (%) Air (%) Road (%) Rail (%) Other (%) rth America Central & South America Western & rthern Europe Central & Eastern Europe Africa Middle East & Indian Sub Cont rth Asia incl China and Taiwan South East Asia Australasia Others Page 2

3 SPECIAL CARGOES Please provide the percentage of your trade in respect of the following cargo Types % Types % Project Bulk Temperature Controlled Breakbulk Tank Dangerous Cargo Flexitank Personal Effects HIGH VALUED CARGOES Please provide number of consignments of the following cargoes per annum where the value including duty exceeds USD50,000 per consignment Spirits Cigarettes / Tobacco Jewelry Types % Types % Work of art Blood stock Gold / silver / platinum objects Please advise if you would carry cargo on an Ad Valerom liability basis. Additional info will be required if Ad Valerom is needed to be considered. FIATA Bill of Lading Own Bill of Lading Sea Waybill Own Air Waybill CONTRACTS Please provide the contract terms and conditions for your trade Own Conditions NFA Conditions CMR te Other (please specify) NFA Conditions Conditions approved by National Freight Forwarders Associations, CMR applies to international road transport in Europe. Please supply the full copy of the contracts. WAREHOUSING Location Please provide the information in respect of your warehousing Size / Area Maximum amount (metric ton) of cargo Maximum value of cargo stored Construction Combustible n-combustibles Your warehousing is for purpose of : In transit Long term (De)consolidation Security measures Gate control CCTV 24 hours guarded Other (please specify) Anti-fire measures Hose reel Extinguisher Auto sprinklers Other (please specify) Page 3

4 OTHER INFORMATION Do you move cargo with transhipment at an intermediate port If yes, do you mention such intermediate port on your Bill of Lading Do you check annually that your sub-contractors have cargo liability insurance If yes, do your sub-contractors liability insurance carry a limit of no less than the limit of your liability insurance Additional info please set out any other info relevant to the insurance of your operation I/We to the best of my/our knowledge hereby confirm that the statements contained in this proposal form are true and correct and I/we have not concealed, misrepresented or misstated any material fact. I/We agree that the statements and declaration contained in this proposal form shall be the basis of the contract of insurance with the Company and are deemed to be incorporated in the contract. Applicant Signature Producer Name Name Contact. Date Date GST Registration Details Q1 : Are you GST registered?. If yes, kindly complete Q2 to Q4. Q2 : GST Registration Q3 : GST Registration Date Q4 : if you are registered for GST, are you purchasing this policy for business purposes? Declaration I/We agreed to notify the Company immediately when there are changes to the above GST Registration Details or if I/we: a) Cease to be GST registered; b) Sell my/own business or part of the business thereof; c) Change my/our GST registration number; or d) Become registered under a new GST identification number. Page 4

5 Financial Services Act (FSA) 2013 The Insured must take reasonable care to ensure that all the answers to the proposal form questions are complete, correct, honest and to the best of Insured s knowledge. The Insured also have a duty to inform the Insurer of any change in the information given to Insurer earlier before the Insurer issue the policy schedule, before Insured renew or change any of the terms of the policy. If Insured s does not, the Insurer may:- (i) declare Insured s policy void from inception (which means treating it as invalid) and the Insurer may not return the premium or recover any unpaid premium; or (ii) cancel this policy and return any premium less the Insurer s cancellation charge or recover any unpaid premium; or (iii) recover any shortfall in premium; or (iv) not pay any Claim that has been or will be made under the policy; or (v) be entitled to recover from the Insured the total amount of any Claim already paid under the policy or any Claim the Insurer have to pay under any relevant legislation, plus any recovery costs. Goods and Services Tax (GST) Please be informed that GST will be implemented by the Government of Malaysia with effect from 1 st April 2015 at a rate of 6%. The Insurer reserves the right to collect from Insured an amount equivalent to the GST payable on the applicable premium for the Policy Period commences before but expires after 1 st April 2015, to collect from Insured an amount equivalent to the GST payable on the applicable premium calculated from 1 st April 2015 on a pro-rated basis. Insured obligation to pay GST shall form part of the terms and conditions in Insured insurance policy. For avoidance of doubt, policies commencing before 1 st April 2015 will exclude GST on the premium amount. However, the Insurer reserve the right to charge GST in addition to the premium amount quoted. For policies commencing after 1 st April 2015, the premium amount quoted will include GST. When the Insurer make a payment under this policy for the acquisition of goods, services or other supplies, the Insurer will reduce the payment by the amount of any input tax credit that Insured are or would entitled to if Insured made a relevant acquisition. The Insurer will pay the GST amount in addition to the Limits of Liability shown in the policy or in the schedule. Where the Limits of Liability shown in the policy or in the schedule are not sufficient to cover the Insured s Loss, the Insurer will only pay an amount for GST that relates to the Insurer s proportion of the Loss. Where Insured are registered for GST, Insured must inform the Insurer the correct input tax credit entitlement each time a Claim is made under this policy. Any fines or penalties arising from Insured incorrect advice are payable by Insured. For the purposes of this condition: GST, credit input tax, acquisition(s), and supply have the same meaning as given to those expressions in the Goods and Services Tax Act 2014 as amended from time to time and such related legislation. Page 5