1. Name of insured
2. Contact name
3. Contact email
4. Contact phone
5. Subsidiary companies to be covered by this insurance, if any:
6. Do you have overseas entities?
Do you want to include them in this coverage?
Please specify entity names
NoCountryEntity Name
7. Please select the plan you wish to be insured
8. Gross Freight Receipts (GFR)* for coming year * Gross revenue including payments to agents and sub-contractors in respect of Insured Services but excluding customs duty, sales tax or similar fiscal charges paid on behalf of the Customer
9. Freight information to be completed:
Specific Freight Turnover (Indicate Percentage)
Containerized (dry)
Containerized (temperature controlled goods)
Household goods and personal effects
Dangerous goods
10. Number of employees:
11. Details on transport services:
Transport services Number of years Turnover
Freight forwarders (as agents using Principal's bills)
NVOCC (as principal issuing own bills of lading)
Customs broker
Road transport operator
Warehouse operator
Marine insurance agent
12. Voyage details
Voyages Percentage of voyages
Asia Pacific
Middle East
North America
South America
13. Do you require cover for Warehousing and Storage operation?
Please list warehouse locations
14. Do you have Standard Trading Conditions?
15. Are your Standard Trading Conditions incorporated into all business transactions with your customers and sub-contractors?
16. Do you annually check your sub-contractors' insurance policies?
17. Do you have any non-standard contracts with your customers and/or principals?
18. Do you have any B/L or AWB or consignment note for road transport under the following
1 FIATA or COMBICON bill of lading Yes No
2 National Freight Forwarder Association bill of lading Yes No
3 Applicant's house bill of lading/house AWB Yes No
4 Any other transportation conditions Yes No
19. Please complete the following
Year GFR No of Claims (if any) Total Claim(s) Amount Brief Details of Claim
Existing Year 2017
Last Year 2016
Two years ago 2015
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Transport and warehousing Insurance in Singapore

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This policy provides coverage for investigation and defence costs with respect to any claim we investigate or settle, or any suit against an insured we defend, to which this insurance applies. The above programs are specially structured to provide you with comprehensive coverage at a premium available only to members of the Singapore Logistics Association. We can also provide customised packages if you have any other requirements. For promotional purposes, Chubb refers to member insurers of Chubb Insurance Singapore Limited. Coverage is underwritten by Chubb Insurance Singapore Limited. The information in this brochure is descriptive only. The precise coverage afforded is subject to the terms and conditions of the insurance policy when issued. Chubb recommends considering our policy wording in deciding whether to acquire or to continue to hold Chubb insurance products. A copy of the standard policy wording may be obtained from Chubb Insurance Singapore Limited through the contact referred to above.

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