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Part I - Company profile

Part II - Modes of operations

Part III - Cargo categories

Part IV - Cargo volume / Turnover

Part V - Past claims record

Part VI - Coverage / Indemnity Limit

Part I – Company profile

Name of Insured:

(if more than one insured name / 

office, please list their names and 

addresses on the supplementary sheet)

Address:

Phone: Fax:

Email: Web site:

Year of Establishment: No. of Staff:

Association:

(List any trade association / professional 

associations which you are a member, e.g. HAFFA, FIATA, IATA)

Name of Principal Executive

Name Title Year of freight

Experience

Years with company

Current insured? Yes □ No □ Limit ________________________

Insured in the past? Yes □ No □ Limit ________________________