Marine Cargo Insurance Proposal Form Company data Policy holder - who will be policy holder? Name of company …….................................................................................................. …….................................................................................................. Address …….................................................................................................. Post code / Town ......................................................................................................... Contact person ......................................................................................................... Phone ......................................................................................................... Telefax ......................................................................................................... Insureds - which other branch offices and/or companies need to be insured? Name Country / Town ......................................................................................................... E-Mail Homepage ......................................................................................................... ............................................................ ............................................................ HDI Global SE Dufourstrasse 46, Postfach 8034 Zürich Tel: +41 44 265 47 47 Fax: +41 44 265 47 48 ............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................
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Marine Cargo Insurance - HDI Global · Marine Cargo Insurance Proposal Form Kind of goods Which kind of goods is to be insured - please indicate particularities: Packing BUYING IN
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Marine Cargo InsuranceProposal Form
Company data
Policy holder - who will be policy holder?
Name of company ……..................................................................................................
Restricted insurance as per art. 2 GCMI 2006 covering loss anddamage when they are the direct consequence of a so-calledspecified accident plus theft and disappearance of entirepackages or of whole consignments yes no
Insurance against all risks as per art. 4 GCMI 2006
Both forms cover loading, transhipment and discharge.
Place to place (Standort/Standort)
Chipping, scratching, grazing or chafing
Additional repair costs
Debris removal costs
Customs and excise duty
War
Mines
Strikes, disturbances, terrorism
Exports protection clause
Subsidiary insurance on imports
Difference in condition / Difference in limits (DIC/DIL)
On deck shipments
30 days intermediate storage
60 days intermediate storage
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noyes
noyes
noyes
noyes
noyes
noyes
noyes
noyes
noyes
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yes no
noyes
yes no
noyes
noyes
yes no
noyes
yes no
noyes
Forms of cover
Extensions of cover - which of the following extensions is needed?