Cargo Insurance Application   NEW ZEALAND AUSTRALIA - ASIA PACIFIC MARINE INSURANCE
Auckland WellingtonSydney VanuatuSingapore Pacific Islands
 
Cargo Transit Freight Insurance QUOTE FORM

PROPOSER DETAILS -
Section 1
Name of Proposer
     
If the Goods are being shipped from Australia,
which State will they be shipped from
 
PARTICULARS OF GOODS TO BE INSURED-
YOU CAN HAVE MULTIPLE CATEGORIES OF GOODS IN ONE SHIPMENT
Section 2
HideCategory #1
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
HideCategory #2
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
HideCategory #3
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
HideCategory #4
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
HideCategory #5
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
HideCategory #6
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
HideCategory #7
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
HideCategory #8
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
HideCategory #9
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
HideCategory #10
Please choose the category that most closely matches the goods to be insured
The description of the category of goods to be insured are described above
If you already have an Inventory of the Goods to be shipped, please attach herewith: or
(Word, Excel, PDF format or JPG)
Alternatively you can fax an Inventory to us on (1800 802 956) Yes No    (You will be contacted by our staff)
 
Except for Livestock, are the goods to be shipped New    Second Hand    Combined
How will the individual items be packed (e.g. cartons)
Will the goods be shipped in fully enclosed containers Yes No
Are the goods to be insured:
a. Over height or over width and will not fit into fully enclosed containers Yes    No
b. A type which requires special lifting apparatus for loading and unloading Yes    No
c. Required to be kept within a specific temperature range Yes    No
d. A type which requires replenishment of refrigerant if the voyage exceeds 12 hours Yes    No
e. A type which is fragile Yes    No
f. Susceptible to rust, oxidization or discoloration Yes    No
g. Subject to an on deck bill of lading Yes    No
What Special Instructions are given to packers, forwarding agents, and carriers for the safe carriage of these goods,if any
  
VOYAGE / CONVEYANCES -
Section 3

Shipping Goods from
Destination of Goods  
Date of departure  
Expected date at destination  

How will the Goods be shipped Sea Air Rail Road Combined

Will the Goods be unloaded & reloaded between the port of shipping & port of destination Yes No

Name of Vessel/Airline or freight company

COVER OPTION DETAILS -
Section 4


OPTION A
(Full Cover)

  • In respect of PROFESSIONALLY PACKED GOODS – All Risks of loss of or damage to the insured goods from any external cause including accidental damage during packing by the carrier.
  • In respect to OWNER PACKED GOODS – Cover is as COVER B below.
  • In respect to MOTOR VEHICLES – All Risks of loss of or damage to the Motor Vehicle(s) excluding loss or damage while being driven under own power except while being driven by an authorized employee of the freight forwarder or their agent for the purposes of loading or unloading.

OPTION B
(Restricted Cover)

Loss of or damage to the insured goods resulting from

  • Fire and/or explosion
  • Collision of vessel, aircraft, or conveyance
  • Overturning and/or derailment of conveyance
  • Crashing and/or forced landing of aircraft
  • Stranding, sinking, or contact of vessel with any external object (ice included) other than water
  • Entry of water into any vessel, hold, container, lift van or place of storage
  • Theft, pilferage or non-delivery

'Exclusions'
RISKS NOT COVERED BY
OPTION A or B

Loss damage or expense caused by
  • Delay.
  • Confiscation or detention by Customs or other officials or authorities.
  • Wear and tear, moths, vermin, normal atmospheric or climatic conditions.
  • Inherent vice.
  • Mechanical, electrical or electronic breakdown or derangement unless there is external evidence of the breakdown or derangement having been caused by an insured risk.
  • Non-delivery of owner packed items unless an itemized, valued list of contents is supplied prior to the commencement of transit.
  • Nuclear matter in terms of the Institute Radioactive Contamination Exclusion Clause current at the date of the policy.

TYPE OF COVER -
Section 5
Do you require All Risk cover Option A
Yes
In certain circumstances ALL RISK cover may not be available. Our quote will detail the cover we are able to provide
Do you require Restricted Cover Option B   Yes

SUM INSURED, VALUATION AND PREMIUM -
Section 6

Value of Goods to be insured
: $

Do you wish to insure the value of Goods, plus
the cost of insurance and freight plus 10%
Yes No

The value for which you insure the Goods for, must be an accurate value otherwise any claim may be reduced by the effect of co-insurance. An example of co-insurance can be found in section 7 below.
EXAMPLE OF CO-INSURANCE -
Section 7

If an Item is valued at $1000 but insured for $500.  Cost of repairs is $600.
The Insurers will pay $500 divided by $1000 x $600 = $300

Subject to full value being declared, if loss or damage occurs as a result of an insured risk, the Company will pay:

  • The reasonable cost of repairs or restoration in the event of damage.
  • FULL REPLACEMENT COST for any items totally lost or destroyed, PROVIDED that such items are no more than 5 years old. 
  • INDEMNITY VALUE for any items totally lost or destroyed, if items are more than 5 years old.  For the purpose of this insurance indemnity value shall mean the replacement cost less an assessed allowance for condition, age, wear and tear.

MOTOR VEHICLES are to be valued at the current market value at destination.


INSURANCE HISTORY -
Section 8
Has the Owner or the Person requesting the quote ever: -        
         
  a. been refused insurance: Yes No  
  b. had an insurance claim of any type refused or reduced: Yes No    
  c. been charged with a crime of any type: Yes No    
 
If Yes to any of the questions above, please give details:


PROPOSER'S DECLARATION -
Section 9

DECLARATION

I, , being a

[Partner, Principal, Director] of the Proposer, hereby declare and warrant: -
     
1.   I am authorized to complete this Proposal on behalf of the Proposer; and;
     
2.


  I have read and understand my obligations of duty of disclosure under the Insurance Contracts Act 1984 and have made enquires to ensure all answers to the questions contained in this Proposal are true and correct to the best of my knowledge and belief and that no information whatsoever has been withheld; and
     
3.   I have read and agree to the 'Terms & Conditions' relating to this Proposal, including matters concerning the 'Privacy Act' and how the information I have provided might be used; and
     
4.   I understand that the submission of this Proposal does not bind or obligate any party to enter into a binding contract of insurance.
 
agree to the above terms         Yes         No

Note: If insurance terms are provided to the Proposer, and the Proposer accepts the terms and wishes to proceed with the insurance cover, the Proposer may be required to physically sign a copy of the Proposal before insurance cover is provided.


Is there anything more you would like to tell us?



CONTACT DETAILS -
Section 10
Preferred Method of Contact Phone     Email
 
Best Time to Call:  
Message:

Thank you we will do our best to respond in the next few hours - but we may need to contact you for further information
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