Marine Cargo Proposal/ Quotation Request
IMPORTANT :
I. PURSUANT TO SECTION 149(4) OF THE INSURANCE ACT 1996 – You are to disclose in this proposal form, fully and faithfully all the facts which you know or ought to know, otherwise the policy issued hereunder ma be void.
II. Signing of this Proposal does not bind the Company to offer or the Proposer to accept, Insurance, but it is agreed that this Proposal shall be the basis of any insurance issued.
III. If there is insufficient space to complete the Proposal, please attach additional sheets.
1. Name of Proposer *
(Nama Pencadang)
2.Proposer Correspondence Address : *
(Alamat Bersurat Pencadang)
4. Years in Business :
Jangkamasa Sudah Beropearasi:
5. Type of Policy required: *
(Jenis Polisi yang Diperlukan)
Required
Explain Others
yang Lain-lain
Types of policies coverage
3. Business Nature (Jenis Perniagaan) : *
Basic Materials Agricultural Chemicals Aluminum Chemicals - Major Diversified Copper Gold Independent Oil & Gas Industrial Metals & Minerals Major Integrated Oil & Gas Nonmetallic Mineral Mining Oil & Gas Drilling & Exploration Oil & Gas Equipment & Services Oil & Gas Pipelines Oil & Gas Refining & Marketing Silver Specialty Chemicals Steel & Iron Synthetics Conglomerates Conglomerates Consumer Goods Appliances Auto Manufacturers - Major Auto Parts Beverages - Brewers Beverages - Soft Drinks Beverages - Wineries & Distillers Business Equipment Cigarettes Cleaning Products Confectioners Dairy Products Electronic Equipment Farm Products Food - Major Diversified Home Furnishings & Fixtures Housewares & Accessories Meat Products Office Supplies Packaging & Containers Paper & Paper Products Personal Products Photographic Equipment & Supplies Processed & Packaged Goods Recreational Goods, Other Recreational Vehicles Rubber & Plastics Sporting Goods Textile - Apparel Clothing Textile - Apparel Footwear & Accessories Tobacco Products, Other Toys & Games Trucks & Other Vehicles Financial Accident & Health Insurance Asset Management Closed-End Fund - Debt Closed-End Fund - Equity Closed-End Fund - Foreign Credit Services Diversified Investments Foreign Money Center Banks Foreign Regional Banks Insurance Brokers Investment Brokerage - National Investment Brokerage - Regional Life Insurance Money Center Banks Mortgage Investment Property & Casualty Insurance Property Management REIT - Diversified REIT - Healthcare Facilities REIT - Hotel/Motel REIT - Industrial REIT - Office REIT - Residential REIT - Retail Real Estate Development Regional - Mid-Atlantic Banks Regional - Midwest Banks Regional - Northeast Banks Regional - Pacific Banks Regional - Southeast Banks Regional - Southwest Banks Savings & Loans Surety & Title Insurance Healthcare Biotechnology Diagnostic Substances Drug Delivery Drug Manufacturers - Major Drug Manufacturers - Other Drug Related Products Drugs - Generic Health Care Plans Home Health Care Hospitals Long-Term Care Facilities Medical Appliances & Equipment Medical Instruments & Supplies Medical Laboratories & Research Medical Practitioners Specialized Health Services Industrial Goods Aerospace/Defense - Major Diversified Aerospace/Defense Products & Services Cement Diversified Machinery Farm & Construction Machinery General Building Materials General Contractors Heavy Construction Industrial Electrical Equipment Industrial Equipment & Components Lumber, Wood Production Machine Tools & Accessories Manufactured Housing Metal Fabrication Pollution & Treatment Controls Residential Construction Small Tools & Accessories Textile Industrial Waste Management Services Advertising Agencies Air Delivery & Freight Services Air Services, Other Apparel Stores Auto Dealerships Auto Parts Stores Auto Parts Wholesale Basic Materials Wholesale Broadcasting - Radio Broadcasting - TV Building Materials Wholesale Business Services CATV Systems Catalog & Mail Order Houses Computers Wholesale Consumer Services Department Stores Discount, Variety Stores Drug Stores Drugs Wholesale Education & Training Services Electronics Stores Electronics Wholesale Entertainment - Diversified Food Wholesale Gaming Activities General Entertainment Grocery Stores Home Furnishing Stores Home Improvement Stores Industrial Equipment Wholesale Jewelry Stores Lodging Major Airlines Management Services Marketing Services Medical Equipment Wholesale Movie Production, Theaters Music & Video Stores Personal Services Publishing - Books Publishing - Newspapers Publishing - Periodicals Railroads Regional Airlines Rental & Leasing Services Research Services Resorts & Casinos Restaurants Security & Protection Services Shipping Specialty Eateries Specialty Retail, Other Sporting Activities Sporting Goods Stores Staffing & Outsourcing Services Technical Services Toy & Hobby Stores Trucking Wholesale, Other Technology Application Software Business Software & Services Communication Equipment Computer Based Systems Computer Peripherals Data Storage Devices Diversified Communication Services Diversified Computer Systems Diversified Electronics Healthcare Information Services Information & Delivery Services Information Technology Services Internet Information Providers Internet Service Providers Internet Software & Services Long Distance Carriers Multimedia & Graphics Software Networking & Communication Devices Personal Computers Printed Circuit Boards Processing Systems & Products Scientific & Technical Instruments Security Software & Services Semiconductor - Broad Line Semiconductor - Integrated Circuits Semiconductor - Specialized Semiconductor Equipment & Materials Semiconductor- Memory Chips Technical & System Software Telecom Services - Domestic Telecom Services - Foreign Wireless Communications Utilities Diversified Utilities Electric Utilities Foreign Utilities Gas Utilities
7. Mode of Packing : *
Cara Persediaan Pakej
Voyage : Import Shipment (Impot)
From (Daripada)
Import Shipment (Impot)
To (Hingga)
6. Insurable Interest (Barangan yang diinsurankan) : *
Basic Materials Agricultural Chemicals Aluminum Chemicals - Major Diversified Copper Gold Industrial Metals & Minerals Major Integrated Oil & Gas Nonmetallic Mineral Oil & Gas Equipment & Services Oil & Gas Pipelines Oil & Gas Refining & Marketing Silver Specialty Chemicals Steel & Iron Synthetics Conglomerates Conglomerates Consumer Goods Appliances Auto Manufacturers - Major Auto Parts Beverages - Brewers Beverages - Soft Drinks Beverages - Wineries & Distillers Business Equipment Cigarettes Cleaning Products Confectioners Dairy Products Electronic Equipment Farm Products Food - Major Diversified Home Furnishings & Fixtures Housewares & Accessories Meat Products Office Supplies Packaging & Containers Paper & Paper Products Personal Products Photographic Equipment & Supplies Processed & Packaged Goods Recreational Goods, Other Recreational Vehicles Rubber & Plastics Sporting Goods Textile - Apparel Clothing Textile - Apparel Footwear & Accessories Tobacco Products, Other Toys & Games Trucks & Other Vehicles Biotechnology Diagnostic Substances Drug Delivery Drug Manufacturers - Major Drug Manufacturers - Other Drug Related Products Drugs - Generic Health Care Plans Home Health Care Hospitals Long-Term Care Facilities Medical Appliances & Equipment Medical Instruments & Supplies Medical Laboratories & Research Medical Practitioners Specialized Health Services Industrial Goods Aerospace/Defense - Major Diversified Aerospace/Defense Products & Services Cement Diversified Machinery Farm & Construction Machinery General Building Materials General Contractors Heavy Construction Industrial Electrical Equipment Industrial Equipment & Components Lumber, Wood Production Machine Tools & Accessories Manufactured Housing Metal Fabrication Pollution & Treatment Controls Residential Construction Small Tools & Accessories Textile Industrial Waste Management Services Advertising Agencies Air Delivery & Freight Services Air Services, Other Apparel Stores Auto Dealerships Auto Parts Stores Auto Parts Wholesale Basic Materials Wholesale Broadcasting - Radio Broadcasting - TV Building Materials Wholesale CATV Systems Computers Wholesale Consumer Services Department Stores Discount, Variety Stores Drug Stores Drugs Wholesale Education & Training Services Electronics Stores Electronics Wholesale Entertainment - Diversified Food Industrial Equipment Medical Equipment Music & Video Publishing - Books Publishing - Newspapers Publishing - Periodicals Specialty Eateries Sporting Equipment Sporting Goods Toy & Hobby Stores Trucking E Wholesale, Other Technology Application Software Business Software & Services Communication Equipment Computer Based Systems Computer Peripherals Data Storage Devices Diversified Communication Services Diversified Computer Systems Diversified Electronics Multimedia & Graphics Software Networking & Communication Devices Personal Computers Printed Circuit Boards Processing Systems & Products Scientific & Technical Instruments Security Software Semiconductor - Broad Line Semiconductor - Integrated Circuits Equipment Semiconductor - Specialized Semiconductor Equipment & Materials Semiconductor- Memory Chips Technical & System Software Telecom Services - Domestic Telecom Services - Foreign Wireless Communications Utilities Diversified Utilities Electric Utilities Foreign Utilities Gas Utilities
Export Shipment (Export) *
From
Export Shipment (Export) *
From (Daripada)
Export Shipment (Ekspot) *
To (Hingga)
Inland Transit ((Transit Darat Sungai) *
From (Daripada)
Inland Transit (Transit Darat Sungai) *
To (Hingga)
Transhipment, please specify if any: *
Limit of Liability : Any one vessel: *
Had Liabiliti: Mana satu penghantaran:
Limit of Liability : Any one barge: *
Had Liabiliti: Mana satu Penghantaran dgn Tongkang
Limit of Liability: Any one aircraft : *
(Had Liabiliti: Yang Mana Satu Penghantaran Udara
Limit of Liability : Any one land conveyance : *
(Had Liabiliti: Yang mana satu penghantaran dgn pengangkutan darat / sungai:)
Estimate Annual Turnover (Anggaran Nilai Pengangkutan Tahunan) : *
Actual Turnover : for past 3 years (Jualan Tepat pada 3 tahun yang lalu)
Eample/Contohnya: RM1,500,000 - year 1997; RM1,000,000 - year 1998. RM1.250,000 - year 1999
Type of Cover : Conditions (Jenis Perlindungan Diperlu dan Keadaan) *
Required
Additonal Information Pertaining to the Cargo Insured (Maklumat Tambahan Bagi Kargo yang perlu diinsurankan)
1. Claims Experience for past 3 years, please specify if any: (Tuntutan yang ada 3 tahun terdahulu, nyatakan bagaimana dan peristiwa berkenaan:-) *
1. Years occured (Tahun peristiwa berlaku)
Required
1
Nature of Loss (Jenis Kerosakan)
2
Nature of Loss
3. Claims Experience for past 3 years, please specify if any: (Tuntutan yang ada 3 tahun terdahulu, nyatakan bagaimana dan peristiwa berkenaan:-) *
3. Years occured (Tahun peristiwa berlaku)
Required
3 *
Nature of Loss
4. Claims Experience for past 3 years, please specify if any: (Tuntutan yang ada 3 tahun terdahulu, nyatakan bagaimana dan peristiwa berkenaan:-) *
4. Years occured (Tahun peristiwa berlaku)
Required
4 *
Nature of Loss
Claims Experience for past 3 years, please specify if any: *
Amount Paid (RM)
2013
2012
2011
2010
Claim Amount - >10K
Claim Amount - 10K to 25K
Claim Amount - 26K to 50K
Claim Amount - 51K to 100K
Claim Amount - <100K
Claim Amount - 100K to 250K
Amount - 250K to 500K
Amount - 501K to 1,000K
Amount - 1mil to 2.5 mil
Amount - 2.5mil to 5 mil
Amount - 5 mil to 10 mil
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