Questionnaire
UK Questionnaire


From :   To :
BROKER: (if any) ACE INSURANCE SA/NV
Address :
Contact :
Phone :
Fax :
E-Mail Address:

REF : Marine Cargo Quotation


INSURED COMPANY : Business activities :
Address :
E-Mail / Website address :

Turnover € (previous 2 years & estimate for next)
N-2 :
N-1 :
Estimated. N


Imports :

Country / Area of origin Goods to be insured Type or carriage Packing Terms of delivery (INCOTERMS) Annual value of transport (€)
Sea
Air
Road
%
%
%
%
%
%
%
%
%

%
%
%
%
%
%
%
%
%
TOTAL :

Exports :

Country / Area of origin Goods to be insured Type or carriage Packing Terms of delivery (INCOTERMS) Annual value of transport (€)
Mer
Air
Terre
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
TOTAL :

 

Limits required : Which max. limit per shipment is needed (€) ?
   
 
Inland transit
Ocean transit
Air transit
Storage
Exhibitions


Vehicles :Are transports carried out with own and/or leased vehicles?

NO

YES
    
Number of vehicles :
Max insured (€) per vehicle :


Containerised shipments : What proportion are shipped FCL/LCL ?

YES
NO

Percent :

%


Deductible :Do you require options ? If so at what level ?

YES
€
NO

 


ADDITIONNAL INFO

Other Transports :

Transports between subsidiaries

FromTo

Goods to be insured

Public carriage
Private carriage
Annual value (€)

Return shipments
Installation tools, max. per transport

Address of warehouse:

This warehouse is :
Own Forwarding agent


Exhibitions? Do you attend exhibitions?
NO YES
How often ?


Previous Insurance :
Do you have existing / previous cover for this risk ? Yes NO
Company Anniversary date
Deductible (€) Limit per shipment (€)


Experience claims
Year
Gross Premium
Claims Number
Claims Paid
Claims Out standing
N-3
N-2
N-1


Basis of premium calculation Per Shipment On Annual Value  
On Turnover Other :