Cargo Enquiry Form

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Terms of Business

Please complete the following Cargo Enquiry form

General:
Company Name:
Address 1:
Address 2:
Post Code:
Telephone No:
E-mail:
Business description:

Type of Firm:	Limited Company
	Partnership
	Sole Trader
	Other
If 'Other' please specify:
When established:
Annual Turnover:	£
Have you had any claims in the last 5 years:	Yes No
If Yes, please give details:

Goods or Products:
Please describe type of goods you require insurance for and how they are packed
Maximum Sum Insured each shipment/consignment	£
Are goods carried in full container loads only?	Yes No

Basis of valuation	CIF + 10% Exports	Yes No
	Ex Works Imports	Yes No

Estimated Value of Annual Shipments to or from -
Europe	£
North America	£
South America	£
Africa	£
Middle East	£
Asia/Far East	£

Australasia	£
Do you issue certificates of insurance?	Yes No
Please advise special conditions of cover required

Percentage of Goods by Road and Sea	%
Percentage of Goods by Road and Air	%
Percentage of Goods by Road only	%

Your name:

Position: