SPECIFIC QUESTIONNAIRE

TRANSPORT OPERATORS
A. NAME & ADDRESS APPLICANT
B. SERVICES TO BE INSURED FREIGHT FORWARDER AS AGENT
FREIGHT FORWARDER AS PRINCIPAL
ROAD TRANSPORT OPERATOR
WAREHOUSE OPERATOR
CUSTOM CLEARANCE
For each box you tick, the corresponding section below must be duly
completed. You can disregard all other sections.
IMPORTANT
This questionnaire is to be duly completed and signed by the insured. In the event insurance is
effected, this questionnaire will form part of the policy and cover is subject to the original signed
questionnaire being received by the Company within 30 days from inception, failing which, the
insurer reserves the right to cancel the policy subject to giving notice in writing of not less than
! days.
"ny changes during the policy period in the nature of the insured#s operations, which materially
changes or alters in any way the information provided in this questionnaire, must immediately be
advised to the Company, failing which, the validity of the policy may be affected.
NAME, POSITION & SIGNATURE DATE
1

C. FREIGHT FORWARDER AS AGENT
C.1. PLEASE ADVISE ANNUAL GROSS FREIGHT RECEIPTS (AGFR) AS AGENT:
C.2. PLEASE INDICATE AS A PERCENTAGE OF ABOVE AGFR YOUR TRAFFIC TO OR FROM EACH
AREA:
WESTERN EUROPE
%
EASTERN EUROPE
%
BALTIC STATES & FORMER SOVIET UNION %
AFRICA
%
MIDDLE EAST
%
FAR EAST
%
INDIAN SUB-CONTINENT
%
AUSTRALIA & NEW ZEALAND %
NORTH AMERICA
%
CENTRAL AMERICA
%
SOUTH AMERICA
%
(TOTAL MUST EQUAL 100% !)
C.. PLEASE INDICATE WHAT PERCENTAGE OF YOUR AGFR IS REPRESENTED BY THE
FOLLOWING CARGOES:
TEMPERATURE CONTROLLED CARGOES %
PERISHABLE CARGOES
%
DANGEROUS CARGOES
%
PHARMACEUTICALS
%
PERSONAL & HOUSEHOLD EFFECTS %
MOBILE PHONES
%
BOTTLED SPIRITS
%
PROCESSED TOBACCO
%
COMPUTERS & COMPUTER PARTS %
TVVIDEODVDRADIO
%
WOR!S OF ART
%
ANTIQUES
%

C.!. PLEASE ADVISE WHETHER YOU TRADE UNDER STANDARD TRADING CONDITIONS WHICH
PROVIDE FOR LIMITED LIABILITY IN NEGLIGENCE:
"ES NO
PLEASE PROVIDE COP"#
C.". PLEASE ATTACH FULL CLAIMS HISTORY OF PAID AND OUTSTANDING CLAIMS INCL. LEGAL
FEES FOR THE PAST " YEARS. FIGURES MUST BE SHOWN NET OF DEDUCTIBLE AND
MENTION APPLICABLE DEDUCTIBLE FOR EACH YEAR.
$
D. FREIGHT FORWARDER AS PRINCIPAL
D.1. PLEASE ADVISE ANNUAL GROSS FREIGHT RECEIPTS (AGFR) AS PRINCIPAL BRO#EN DOWN
BETWEEN:
SEA TRAFFIC %
AIR TRAFFIC %
ROAD TRAFFIC %
RAIL TRAFFIC %
RIVER TRAFFIC %
WAREHOUSING %
D.2. PLEASE INDICATE AS A PERCENTAGE OF ABOVE AGFR YOUR TRAFFIC TO, FROM OR
WITHIN EACH AREA:
WESTERN EUROPE
%
EASTERN EUROPE
%
BALTIC STATES & FORMER SOVIET UNION %
AFRICA
%
MIDDLE EAST
%
FAR EAST
%
INDIAN SUB-CONTINENT
%
AUSTRALIA & NEW ZEALAND %
NORTH AMERICA
%
CENTRAL AMERICA
%
SOUTH AMERICA
%
(TOTAL MUST EQUAL 100% !)
D.. PLEASE INDICATE WHAT PERCENTAGE OF YOUR AGFR IS REPRESENTED BY THE
FOLLOWING CARGOES:
TEMPERATURE CONTROLLED CARGOES %
PERISHABLE CARGOES
%
DANGEROUS CARGOES
%
PHARMACEUTICALS
%
PERSONAL & HOUSEHOLD EFFECTS %
MOBILE PHONES
%
BOTTLED SPIRITS
% PROCESSED TOBACCO
%
COMPUTERS & COMPUTER PARTS %
TVVIDEODVDRADIO
%
WOR!S OF ART
%
ANTIQUES
%

D.!. WHEN YOU ISSUE BILLS OF LADING, PLEASE ADVISE:
$) &) FOR CONTAINERISED CARGOES' NUMBER OF TEU SHIPPED ANNUALL"
&&) FOR NON-CONTAINERISED GENERAL CARGOES' NUMBER OF METRIC TONS
SHIPPED ANNUALL"
&&&) FOR BUL! CARGOES' NUMBER OF METRIC TONS SHIPPED ANNUALL"
TEU

MT
MT
(
%) UNDER WHICH BILL OF LADING DO "OU TRADE%
&) FIATA BL% "ES NO
&&) COMBICON BL% "ES NO
&&&) HOUSE BL% "ES NO - PLEASE PROVIDE COP" OF BOTH FRONT
& REVERSE SIDE OF HOUSE BL#
&) &&&) PERCENTAGE OF "OUR TRADE THAT IS CONTRACTED PORT-TO-PORT
&)) PERCENTAGE OF "OUR TRADE THAT IS CONTRACTED DOOR-TO-DOOR
%
%
') &) PERCENTAGE OF "OUR TRADE THAT IS SUB-CONTRACTED PORT-TO-PORT
&&) PERCENTAGE OF "OUR TRADE THAT IS SUB-CONTRACTED DOOR-TO-DOOR
%
%
() WHETHER %
(A) "OU CONTRACT AS PRINCIPAL FOR INLAND DESTINATIONS WITHIN ONE OF THE
FOLLOWING COUNTRIES AND
(B) IF SO' WHETHER THE OCEAN CARRIER*S BL WOULD ALSO COVER THE INLAND
TRANSPORTATION%
&) AFRICAN COUNTRIES
&&) SOUTH & CENTRAL AMERICAN COUNTRIES
&&&) FORMER SOVIET UNION & BALTIC STATES
&)) CHINA
)) REPUBLIC OF "EMEN
(A)
"ES NO
"ES NO
"ES NO
"ES NO
"ES NO
(B)
"ES NO
"ES NO
"ES NO
"ES NO
"ES NO
D.". WHEN YOU ISSUE YOUR OWN AIR WAYBILL, PLEASE ADVISE:
$) &) PERCENTAGE OF "OUR TRADE THAT IS CONTRACTED AIRPORT-TO-
AIRPORT
&&) PERCENTAGE OF "OUR TRADE THAT IS CONTRACTED DOOR-TO-DOOR
%
%
%) IN THE EVENT OF DOOR-TO-DOOR' WHICH CONTRACT TERMS APPL" TO THE PRE-CARRIAGE TO
ANDOR THE ON-CARRIAGE FROM THE AIRPORT+
PLEASE PROVIDE A COP"#
D.). WHEN ARRANGING ROAD HAULAGE SERVICES, PLEASE ADVISE:
$) UNDER WHICH CONTRACT TERMS "OU TRADE# IF DIFFERENT TO C#M#R#-CONDITIONS' PLEASE
PROVIDE A COP"#
%) WHETHER "OU CHEC! THE SUB-CONTRACTOR*S INSURANCE ARRANGEMENTS PRIOR TO USING
HIS SERVICES% "ES NO
D.*. WHEN ARRANGING TRANSPORT BY RAIL, PLEASE ADVISE UNDER WHICH CONTRACT
TERMS YOU TRADE. IF DIFFERENT TO C.I.M.+CONDITIONS, PLEASE PROVIDE A COPY.
D.,. WHEN ARRANGING TRANSPORT BY RIVER, PLEASE ADVISE:
$) UNDER WHICH CONTRACT TERMS "OU TRADE# PLEASE PROVIDE A COP"#
%) WHETHER "OU CHEC! IF THE SUB-CONTRACTOR HAS ADEQUATE P&I-INSURANCE IN PLACE
PRIOR TO USING HIS SERVICES% "ES NO
,
D.-. WHEN ARRANGING WAREHOUSING SERVICES, PLEASE ADVISE:
$) UNDER WHICH CONTRACT TERMS "OU TRADE# PLEASE PROVIDE A COP"#
%) WHETHER "OU CHEC! THE SUB-CONTRACTOR*S INSURANCE ARRANGEMENTS PRIOR TO USING
HIS SERVICES% "ES NO
&) WHETHER "OU ARRANGE FOR%
IN-TRANSIT STORAGE
LONG TERM STORAGE
CONSOLIDATION & DECONSOLIDATION
TEMPERATURE CONTROLLED STORAGE
CUSTOMS BONDED STORAGE
D.1.. PLEASE ATTACH FULL CLAIMS HISTORY OF PAID AND OUTSTANDING CLAIMS INCL.
LEGAL FEES FOR THE PAST " YEARS. FIGURES MUST BE SHOWN NET OF DEDUCTIBLE AND
MENTION APPLICABLE DEDUCTIBLE FOR EACH YEAR.
-
E. ROAD TRANSPORT OPERATOR
E.1. PLEASE ADVISE:
A# ANNUAL GROSS FREIGHT RECEIPTS (AGFR) %
B# NUMBER OF TRUC!HEADS "OU OPERATE%
E.2. PLEASE INDICATE AS A PERCENTAGE OF ABOVE AGFR YOUR TRAFFIC TO, FROM OR
WITHIN EACH AREA:
EUROPEAN UNION E.CL# ITAL" %
ITAL"
%
BALTIC STATES
%
FORMER SOVIET UNION
%
EASTERN EUROPE
%
TUR!E"
%
MAGHREB COUNTRIES
%
MIDDLE EAST
%
INDIAN SUB-CONTINENT
%
AUSTRALIA & NEW ZEALAND
%
AFRICA
%
FAR EAST LESS CHINA
%
CHINA
%
NORTH AMERICA
%
CENTRAL AMERICA
%
SOUTH AMERICA
%
(TOTAL MUST EQUAL 100% !)
E.. PLEASE INDICATE WHAT PERCENTAGE OF YOUR AGFR IS REPRESENTED BY THE
FOLLOWING CARGOES:
TEMPERATURE CONTROLLED CARGOES %
PERISHABLE CARGOES
%
DANGEROUS CARGOES
%
PHARMACEUTICALS
%
PERSONAL & HOUSEHOLD EFFECTS %
MOBILE PHONES
%
BOTTLED SPIRITS
%
PROCESSED TOBACCO
%
COMPUTERS & COMPUTER PARTS %
TVVIDEODVDRADIO
%
WOR!S OF ART
%
ANTIQUES
%

E.!. PLEASE ADVISE UNDER WHICH CONTRACT TERMS YOU TRADE. IF DIFFERENT TO C.M.R.+
CONDITIONS, PLEASE PROVIDE A COPY.
/
E.". PLEASE ADVISE AS A PERCENTAGE OF YOUR AGFR TRAFFIC YOU SUB+CONTRACT:
LESS THAN 10%
BETWEEN 10% AND $-%
BETWEEN $-% AND -0%
BETWEEN -0% AND 0-%
BETWEEN 0-% AND 11%
100 %
0
E.). WHEN YOU SUB+CONTRACT PART OF YOUR TRAFFIC, PLEASE ADVISE:
A# WHETHER "OU CHEC! THE SUB-CONTRACTOR*S INSURANCE ARRANGEMENTS PRIOR TO
USING HIS SERVICES% "ES NO
B# WHETHER "OU OBTAIN AN INSURANCE CERTIFICATE FROM THE SUB-CONTRACTOR%
"ES NO
E.*. PLEASE ADVISE:
A# WHETHER "OU ONL" OPERATE OWNED OR LEASED TRAILERS% "ES NO
B# IF NOT' DO "OU WISH TO INSURE "OUR LIABILIT" FOR DAMAGE TO OR LOSS OF TRAILERS
BELONGING TO THIRD PARTIES% "ES NO
E.,. DO YOU OPERATE A WAREHOUSE/ "ES NO# IF "ES' PLEASE COMPLETE SECTION F#
E.-. DO YOU PAR# LADENTRAILERS AT A SECURE PAR#ING AREA OVERNIGHT/ "ES NO#
IF "ES' PLEASE PROVIDE SECURIT" ARRANGEMENTS#
E.1.. PLEASE ATTACH FULL CLAIMS HISTORY OF PAID AND OUTSTANDING CLAIMS INCL.
LEGAL FEES FOR THE PAST " YEARS. FIGURES MUST BE SHOWN NET OF DEDUCTIBLE AND
MENTION APPLICABLE DEDUCTIBLE FOR EACH YEAR.
2
F. WAREHOUSE OPERATOR
F.1. PLEASE ADVISE ANNUAL GROSS RECEIPTS OUT OF WAREHOUSING:
F.2. PLEASE ADVISE ADDRESS OF EACH WAREHOUSE LOCATION:
F.. PLEASE DESCRIBE PREMISES:
A# WHAT IS THE GROUND FLOOR AREA IN M3 +
B# HOW MAN" STORIES +
C# TOTAL AREA OF PREMISES AVAILABLE FOR STORAGE +
D# AN" BASEMENT USED FOR STORAGE + "ES NO # IF "ES' IS BASEMENT PROTECTED
B" AUTOMATIC PUMP AND IS CARGO STORED ON SHELVES OR PALLETS +
E# "EAR BUILT% # IF RECENTL" REMODELLED' PLEASE ADVISE WHEN%
F# WHAT !IND OF CONSTRUCTION MATERIAL%
WALLS%
ROOF%
F.!. PLEASE DESCRIBE PREMISES PROTECTION:
A# IS LOCATION SPRIN!LERED + "ES NO
B# LIST AN" OTHER FIRE PROTECTION%
C# WHAT DISTANCE TO NEAREST RESPONDING FIRE DEPARTMENT%
D# IS THERE AN" BURGLAR ALARM S"STEM + "ES NO# IF "ES' IS IT CONNECTED WITH
POLICE STATION ANDOR SECURIT" SERVICE + "ES NO
E# DO "OU EMPLO" WATCHMEN%
(&) DURING WOR!ING HOURS% "ES NO
(&&) $,$, HRS AND 00 DA"S% "ES NO
F# DO "OU HAVE CLOSED CIRCUIT TV + "ES NO
G# PLEASE LIST AN" OTHER POSSIBLE !IND OF PREMISES PROTECTION%
1
F.". PLEASE PROVIDE:
A# MA.IMUM VALUE IN THE WAREHOUSE AT AN" ONE TIME%
B# AVERAGE VALUE IN THE WAREHOUSE AT AN" ONE TIME%
F.). PLEASE INDICATE WHICH OF THE FOLLOWING SERVICES YOU PROVIDE:
IN-TRANSIT STORAGE
LONG TERM STORAGE
CONSOLIDATION & DECONSOLIDATION
TEMPERATURE CONTROLLED STORAGE
CUSTOMS BONDED STORAGE
F.*. PLEASE INDICATE WHAT PERCENTAGE OF YOUR WAREHOUSING IS REPRESENTED BY THE
FOLLOWING CARGOES:
TEMPERATURE CONTROLLED CARGOES %
PERISHABLE CARGOES
%
DANGEROUS CARGOES
%
PHARMACEUTICALS
%
PERSONAL & HOUSEHOLD EFFECTS %
MOBILE PHONES
%
BOTTLED SPIRITS
%
PROCESSED TOBACCO
%
COMPUTERS & COMPUTER PARTS %
TVVIDEODVDRADIO
%
WOR!S OF ART
%
ANTIQUES
%

F.,. PLEASE ADVISE UNDER WHICH CONTRACT TERMS YOU TRADE. PLEASE PROVIDE A COPY.
F.-. PLEASE ADVISE AS A PERCENTAGE OF YOUR ANNUAL GROSS RECEIPTS YOU SUB+
CONTRACT:
LESS THAN 10%
BETWEEN 10% AND $-%
BETWEEN $-% AND -0%
BETWEEN -0% AND 0-%
BETWEEN 0-% AND 11%
100 %
F.1.. WHEN YOU SUB+CONTRACT, PLEASE ADVISE:
A# WHETHER "OU CHEC! THE SUB-CONTRACTOR*S INSURANCE ARRANGEMENTS PRIOR TO
USING HIS SERVICES% "ES NO
B# WHETHER "OU OBTAIN AN INSURANCE CERTIFICATE FROM THE SUB-CONTRACTOR%
"ES NO
F.11. PLEASE ATTACH FULL CLAIMS HISTORY OF PAID AND OUTSTANDING CLAIMS INCL.
LEGAL FEES FOR THE PAST " YEARS. FIGURES MUST BE SHOWN NET OF DEDUCTIBLE AND
MENTION APPLICABLE DEDUCTIBLE FOR EACH YEAR.
10
G. CUSTOM CLEARANCE
G.1. PLEASE ADVISE ANNUAL GROSS INCOME IN RESPECT OF CUSTOM CLEARANCE,
E0CLUDING DUTIES AND TA0ES PAID BY CUSTOMERS:
G.2. PLEASE ADVISE WHETHER YOUR COMPANY:
A) POSSESES THE NECESSAR" LICENSES AS REQUIRED B" LAW TO ACT AS A CUSTOM AGENT%
"ES NO
B) SUB-CONTRACTS THE CUSTOM CLEARANCE TO THIRD PARTIES% "ES NO
G.. PLEASE INDICATE:
A) WHETHER "OUR COMPAN" HAS A CUSTOMS BOND% "ES NO
B) WHETHER "OU ARRANGE CUSTOM CLEARANCE' INCLUDING ISSUING T-FORMS' FOR
TRANSPORT ANDOR STORAGE OF SPIRITS ANDOR CIGARETTES% "ES NO
C) IF THE ANSWER UNDER B IS "ES' PLEASE ADVISE WHICH SECURIT" ARRANGEMENTS "OU
MA!E%
D) WHETHER "OU HAVE A SPECIAL PROCEDURE IN PLACE FOR CHEC!ING THE RELIABILIT"
AND FINANCIAL STATUS OF "OUR CUSTOMERS% "ES NO
IF "ES' PLEASE SPECIF"%
G.!. PLEASE ATTACH FULL CLAIMS HISTORY OF PAID AND OUTSTANDING CLAIMS INCL.
LEGAL FEES FOR THE PAST " YEARS. FIGURES MUST BE SHOWN NET OF DEDUCTIBLE AND
MENTION APPLICABLE DEDUCTIBLE FOR EACH YEAR.
11