Transportation Insurance

Transportation Insurance Proposal form Completing the Proposal form 1. This application must be completed in full including all required attachments. 2. If more space is needed to answer a question, please attach a separate sheet with details. 3. The term proposer, whenever used in this proposal form shall mean the Insured listed and all subsidiary companies of the Insured for which coverage is proposed under this proposal. 4. The term Insured and subsidiaries have the same meaning in this proposal form as in the policy. Duty of disclosure For policyholders who are not a natural person, before you enter into an insurance contract, you have a duty to tell us anything that you know, or could reasonably be expected to know, may affect our decision to insure you and on what terms. You have this duty until we agree to insure you. You have the same duty before you renew, extend, vary or reinstate an insurance contract. You do not need to tell us anything that: reduces the risk we insure you for; or is common knowledge; or we know or should know as an insurer; or we waive your duty to tell us about. Individuals If you are the policyholder and you are a natural person, a different duty of disclosure to the one set out above applies to you. Contact your intermediary or us to ensure you are notified of your duty. If you do not tell us something If you do not tell us anything you are required to, we may cancel your contract or reduce the amount we will pay you if you make a claim, or both. If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed. Privacy Zurich is bound by the Privacy Act 1988. We collect, disclose and handle information, and in some cases personal or sensitive (eg health) information, about you ( your details ) to assess applications, administer policies, contact you, enhance our products and services and manage claims ( Purposes ). If you do not provide your information, we may not be able to do those things. By providing us, our representatives or your intermediary with information, you consent to us using, disclosing to third parties and collecting from third parties your details for the Purposes. We may disclose your details, including your sensitive information, to relevant third parties including your intermediary, affiliates of Zurich Insurance Group Ltd, insurers, reinsurers, our service providers, our business partners, health practitioners, your employer, parties affected by claims, government bodies, regulators, law enforcement bodies and as required by law, within Australia and overseas. We may obtain your details from relevant third parties, including those listed above. Before giving us information about another person, please give them a copy of this document. Laws authorising or requiring us to collect information include the Insurance Contracts Act 1984, Anti- Money Laundering and Counter-Terrorism Financing Act 2006, Corporations Act 2001, Autonomous Sanctions Act 2011, A New Tax System (Goods and Services Tax) Act 1999 and other financial services, crime prevention, trade sanctions and tax laws. Zurich s Privacy Policy, available at www.zurich.com.au or by telephoning us on 132 687, provides further information and lists service providers, business partners and countries in which recipients of your details are likely to be located. It also sets out how we handle complaints and how you can access or correct your details or make a complaint. ZU12148 - V4 10/15 - CGEL-010650-2015 Reasonable precautions and fraudulent acts You must take all reasonable precautions for the maintenance and safety of the Insured Property and prevention of loss. We will not be liable for any loss, damage, injury or liability arising from a deliberate or fraudulent act committed by you or on your behalf. Policy details For full details of cover, please refer to the Product Disclosure Statement and Policy wording which sets out the terms and conditions of cover offered. This is available from your local Zurich Office or your intermediary. Zurich Australian Insurance Limited ABN 13 000 296 640, AFS Licence No. 232507. 5 Blue Street North Sydney NSW 2060. Transportation Proposal Form Page 1 of 10

New business or Renewal Policy number 1 Proposed period of insurance Period of insurance From / / To / / at 4pm, local time 2 Applicant details 1. Full name of person/s or organisation to be insured including trading name/s (the Business). Where the applicant is a company, please give the name of the company and their subsidiaries requiring cover. 2. Address State Postcode 3. Contact details Business ( ) Fax ( ) Mobile Email 4. Does the applicant have a Website on the Internet? Yes No If 'Yes', please provide URL 3 The Business 1. Please describe the main activities of the Business 2. Please outline the main destinations/cities vehicles travel to/from 3. Where is your main base of operations 4. Other depots locations 5. Does the applicant hold any current accreditation/affiliation? Yes No of such accreditation/affiliation and date accredited/affiliated 6. Has there been a change in the applicant s operations (i.e. acquisitions, significant Health and Safety enhancements) during the past 12 months. Yes No If Yes, provide details 7. Nominate your major current contracts Transportation Proposal Form Page 2 of 10

3 The Business (continued) 8. Please indicate the nature of goods carried and the respective percentages General (Non Hazardous) % Refrigerated Goods % Hanging Meat % Livestock % Logs/Harvested Timber % Hazardous Goods % Vehicles including machinery % Other (please specify) % 9. Please provide details of any dangerous or hazardous goods carried. You may need to complete our dangerous goods questionnaire if you require more than $1m limit of liability. 10. Please detail operating radius and the respective percentage(s) Up to 250kms % Over 250kms to 600kms % Over 600kms to 1000kms % Over 1000kms % 11. Do you have or intend to have any additional insurance with any other insurer in connection with these classes of insurance in respect of the same property of risk as you are now proposing? Yes No If Yes, provide details 12. Is there any additional information or detail of which you are aware and which may assist Zurich to better assess the nature of the risks? Yes No If Yes, provide details Section 1 Motor Fleet 4 Fleet details Do you require this cover? Yes No 1. Please attach a detailed schedule of vehicles to be insured including sum insured, state registered any other pertinent information (leasing or finance arrangements etc). 2. Please outline historical vehicle numbers and excess for the past 5 years (NOTE: Minimum 3 years to be provided) Period Number of Vehicles Total Fleet Value Excess Level To To To To To 3. Please outline the basis of rating or premium terms for the last 3 years 4. Are any of your vehicles in a unsafe, unroadworthy or damaged condition? Yes No If Yes, provide details Transportation Proposal Form Page 3 of 10

4 Fleet details (continued) 5. What percentage of your work involves express, time sensitive and/or overnight freight? % 6. Do you operate articulated tipping trailers? Yes No If Yes how many do you operate 7. Are B-Double units used? Yes No If Yes, please advise: (a) What would be the highest B Double combination value? Detail which items in the schedule with full description and value (b) What would be the average B-Double combination value? (c) How many B-Double combinations are in operation? 8. Are any Road Trains/B-Triples used (Note: Road Train is defined as having more than 2 goods carrying trailers). Yes No If Yes, please advise: (a) How many Road Train/B Triple combinations are in operation? (b) Details of Road Train/B Triple operations including locations? (c) What would be the highest Road Train/B Triple combination value? Detail which items in the schedule? (i.e. full description and values of each vehicle in the combination including dolly s) 9. Are any vehicles governed/speed limited? Yes No 10. Are any units fitted with a GPS tracking device or downloadable Engine Management System (EMS) Yes No 11. How many drivers (of all employment types) do you currently have working? 12. What percentage of these are: Sub contractors/agency drivers % Casual % Tow Operators % Permanent % 13. Are your drivers involved in loading/unloading? Yes No 14. Is there a Non Owned Trailer Liability exposure? Yes No If Yes, is this cover required? Yes No and limit of cover required 15. Does the insured have an in-house maintenance team? Yes No Transportation Proposal Form Page 4 of 10

4 Fleet details (continued) Drivers 1. Does your company have a formal driver manual outlining company policy and procedure? Yes No 2. Are there any drivers under 25 years of age or drivers without 2 years practical experience? Yes No 3. What was the driver turnover during the last 12 months % 4. What is the usual length of time drivers stay with the company? 5. Are drivers required to complete a questionnaire of employment? Yes No 6. How frequently do you conduct medical examinations for your drivers? Annually Every 2 years 3 to 5 years Dependent on driver age Never If dependant on driver age, provide details 7. Does the medical include: Diagnosis for sleeping disorders Yes No Eyesight and Hearing Tests Yes No Flexibility Tests Yes No If Yes, provide details 8. Describe the criteria for driver selection 9. Describe driver training programs, if any 10. What driver performance review system (i.e. KPI s) do you have in place? 11. What percentage of time do drivers drive continuously between 11.00pm and 6.00am? % 12. When night-work exceeds 2 consecutive periods, what provisions are made for a driver to recover from any potential loss of sleep? 13. Do you have effective fatigue monitoring systems? Yes No 14. What fatigue management systems do you have in place? 15. Are all drivers educated in the benefits of a healthy diet and lifestyle? Yes No 16. Do you have a drug/alcohol testing program? Yes No if Yes, please provide details 17. Any additional information Transportation Proposal Form Page 5 of 10

4 Fleet details (continued) Security 1. Are vehicles garaged at one place? Yes No 2. What is the maximum value of all vehicles at any one location? $ 3. Where is that location? 4. Are vehicles garaged in: (a) Unsecured open area? Yes No (b) Secured locked compound? Yes No (c) Enclosed covered area? Yes No 5. Does security lighting exist? Yes No 6. Do security guards patrol the depot? Yes No 7. Are keys left with vehicles? Yes No 8. Other additional information Section 2 Business Resilience Cover 5 Do you require this cover? Yes No If Yes, please complete the details below Would you like to restrict this cover to certain vehicles? Yes No If Yes, how many vehicles would like this cover to apply to If Yes, provide the registration numbers of the vehicles that you would like this cover to apply to Total Income $ Indemnity Period (Months) 1 month 2 months 3 months other If you wish to restrict this cover to certain vehicles please list the registration numbers of those vehicles below: Business Resilience Cover is designed to cover loss of freight earnings if one of your vehicles is determined to be a total loss. It is also designed to compliment a business continuity plan to insure that you have the funds to cover any increased costs to maintain your business. We will pay you the freight earnings less working expenses, including any increased costs (for example leasing other vehicles) that you incur to maintain income provided that the costs do not exceed the income obtained by incurring these costs. Example of Business Resilience Sum Insured Calculation To ensure that you select an adequate sum insured you need to consider the following: The maximum annual Freight Earnings of vehicle(s) in your fleet that would affect your business if written off $ Less working expenses for the vehicle(s) Maintenance, Fuel Oil $ Additional Uninsured working expenses related to this vehicle that you do not want to insure Payroll of drivers that you do not need to reimburse $ $ $ Total Working Expenses $ Insured Annual Income $ Using the above information calculate a sum insured that will reimburse these costs during the indemnity period selected. Note if the earnings from the vehicle(s) are seasonal you should ensure that the sum insured selected will be adequate if the vehicle was unable to operate during the busiest period. Transportation Proposal Form Page 6 of 10

Section 3 Goods in Transit (Carriers) Insurance 6 Do you require this cover? Yes No Cover Please indicate the cover option required Cover Option 1 Comprehensive Cover Option 2 Defined Events If Cover Option 2 is taken please indicate any optional events required Theft, Pilferage, Non-delivery Yes No Accidental loss/damage during loading and unloading Yes No Breakdown, malfunction or mismanagement of refrigerating machinery Yes No Sum Insured Maximum liability in any one vehicle $ Maximum liability any one event $ Excess required (in addition to any compulsory excess which may apply) Yes No Financial Estimated Annual Gross Freight Earnings Refrigerated goods $ Livestock $ Household removals $ General goods $ Total $ Section 4 Carriers Cargo Liability Insurance 7 Do you require this cover? Yes No 1. Do you use any Conditions of Carriage? Yes No If Yes please attach a sample of your consignment note 2. Are your standard Conditions of Carriage advised to clients prior to commencement of transit? Yes No of your process If No, please provide details of circumstances when Conditions or Carriage are not advised 3. Do you accept liability or arrange special contracts where your liability is different from that under your standard Conditions of Carriage? Yes No 4. If Yes, do you require an extension to cover your liability for loss of or damage to goods or livestock carried under special contracts? Yes No If Yes, please attach a copy of each contract 5. Do you offer to insure your client s goods? Yes No Transportation Proposal Form Page 7 of 10

7 Carriers Cargo Liability Insurance (continued) Cover Maximum liability in any one vehicle $ Maximum liability for any one event $ Do you require an excess Yes No Optional Extension Do you require liability cover when subcontractors carry for you? Yes No Financial Estimated annual gross freight earnings as a principal carrier and including freight paid to subcontractors protected by the terms of you standard consignment note $ Estimated annual gross freight earnings when sub contracting for other carriers $ Total estimated gross freight earnings $ If you require extended cover for special contracts, please state the gross freight earnings for these contracts $ If you require an optional extension to cover the liability of subcontractors, please state the gross freight earnings paid to them $ Section 5 Combined General and Products Liability Insurance 8 Do you require this cover? Yes No Cover General Liability $ any one occurrence Products Liability $ any one period of insurance Excesses General / Products Liability $ Work away from premises % USA exports $ Turnover $ Number of staff including principals Wages $ 1. (a) Do you require property owners liability cover on property which you do not occupy? Yes No (b) Declared Asset Values up to $1mill $2mill $3mill $4mill (c) Address of property to be insured State Postcode 2. Do your operations include: (a) Use or storage of explosives? Yes No (b) Welding away from your premises? Yes No (c) Boilers and/or compressors which require Government Certificates? Yes No (d) Manufacture, distribution, storage, transportation of chemicals or other toxic or harmful matter? Yes No (e) Construction work Yes No If Yes, to any of the above please specify Transportation Proposal Form Page 8 of 10

8 Section 5 Combined General and Products Liability Insurance (continued) 3. Attach details of any liability assumed by written or verbal contract including Hold Harmless Agreements. 4. Do you subcontract any work to others? Yes No If Yes (a) What wages do you pay to your Subcontractors? $ (b) Specify the type of work subcontracted (details) Do you check that your Subcontractors have public liability cover? Yes No Note: You should check that their cover includes your interest as a principal. Optional Extension Do you require liability cover when Subcontractors carry goods for you? Yes No 9 All sections For all Sections list all claims and uninsured losses, damage or liabilities that have involved your business during the past five years. Date of loss Cover Description Insurer Amount Note: Claims information must be provided in writing from previous insurer(s). Transportation Proposal Form Page 9 of 10

9 All sections (continued) Has any insurance company in connection with these classes of insurance (a) Declined to accept a proposal from you? Yes No (b) Cancelled a policy, contrary to your wishes? Yes No (c) Declined to renew a policy, contrary to your wishes? Yes No Has any insurance company refused to meet a claim lodged by you or by any person named as the proposer herein, in respect of these classes of insurance? Yes No Has any insurance company succeeded in denying a claim lodged by you or any person named as the proposer herein on the grounds of non-disclosure, misrepresentation and/or fraud, in respect of these classes of insurance? Yes No 10 Declaration In accordance with my/our duty of disclosure, I/we declare that the whole of these answers in the Questionnaire are true, that I/we have withheld no information whatsoever that might tend in any way to increase Zurich s risk, or to influence its decision regarding this information; and that I/we have not proposed for insurance in excess of the actual value of the motor vehicles described, and I/we undertake to exercise care, and reasonable precautions for the safety of the said motor vehicles. I/we agree that this Proposal and Declaration shall be the basis of the contract between me/us and Zurich. I/We authorise Zurich to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service. I/we further agree that if this Questionnaire, in any part is filled in by any other person, such person shall be deemed my/our agent(s) and not the agent of the Company. Signature of proposers Date / / Save File Print Form Transportation Proposal Form Page 10 of 10