Trade Risk
Assured Detail
Contact Person:
Company:
E-mail:
Tel (w):
Fax:
Applicant Detail
Name of Person Completing the Application:
Please provide your name here.
Telephone (including dialing code):
Please insert your telephone number here. Don't forget the dialing code.
Mobile Number:
If applicable, insert your cellular phone number here.
Fax Number (including dialing code):
Please insert your fax number here. Don't forget the dialing code.
Subject Matter
Description of Subject Matter:
Please describe the subject matter to be insured. Provide details of the quantity
of items and any specifics regarding the subject matter.
Commodity Classification:
Please select the commodity that most closely relates to the goods being insured.
If no commodity classification covers the goods to be insured, please select
'Other' in the list and describe the commodity below.
If 'Other' Selected, please describe:
If 'Other' was selected in the Commodity Classification list, please describe
the commodity here.
New or Second Hand: New Second Hand
Please indicate whether the goods are new or second hand. Note if the goods
are second hand, an automatic quote cannot be generated as a preshipment
survey will be required.
Terms of Sale/Purchase (INCO Term):
Please select the appropriate terms of sale or purchase.
Insured Value
Currency:
Specify the currency in which the Invoice Value and Additional Charges
below are stated.
Invoice Value:
The invoice value normally represents the sales or the purchase price
of the goods, or in the case of an inter-branch transfer, the transfer
price. This amount is required.
Additional Charges (that are to be insured and that are not included in the Invoice Value):
This value is intended to take into account any additional costs NOT ALREADY
INCLUDED in the Invoice Value above. Examples of these costs are the costs of
transportation or any storage costs that will be incurred prior to delivery to final
destination.
Basis of Valuation:

The basis of valuation is at your option and depends on the transaction that is taking place. Please select the basis that best
suits you. If none of these suit, please select Other and describe the required basis of valuation in the area below.
Other Basis of Valuation:
The invoice value normally represents the sales or the purchase price of the
goods, or in the case of an inter-branch transfer, the transfer price. This
amount is required.
Markup Percentage: %
The markup percentage is at your option. It is normally between 10% and
20%. It is included to cater for any potential increased costs involved in
re-ordering the goods should they get lost or damaged. It is permissible to
markup higher than 20% but this will cause the quote to default to the Risk
Profile Centre for verification.
Conveyance
Mode of Shipment:
Shipping Method:
Trip
Date of Departure: Please click on the PopUp Calendar to select the date
Please note that quotations cannot be provided for shipments that have
already departed.
Name of Vessel:
If this shipment is going by air, please indicate Airfreight in this field.
From Country:
Please indicate this shipment's country of origin.
From Place:
Provide the name of the town/city.
Transhipment Country:
If this shipment is being transhipped, please indicate the country in which
transhipment is taking place.
Transhipment Place:
Please indicate the place of transhipment.
Final Delivery Country:
Please indicate this shipment's country of final delivery.
Final Delivery Place:
Provide the name of the town/city.
Will the conditions of the Institute Classification Clause and the Cargo ISM Endorsement be complied with?
Please indicate your compliance with the Institute Classification Clause and the
Cargo ISM Endorsement.
Is either of these countries or any country that the cargo may pass through in the course of transit a UN Sanctioned Country?
Please indicate whether the shipment will pass through any UN sanctioned countries.
Do you require SASRIA cover?
SASRIA cover is applicable to shipments to, from or within the Republic of South Africa.
Storage (other than in the normal course of transit)
Number of Days Storage prior to Final Delivery:
In the event that the goods will be placed into storage PRIOR TO DELIVERY
TO FINAL DESTINATION, please provide the number of days they will be in
store. Note that storage in the normal course of transit is provided automatically
and should not be declared here.
Storage Location to be Used (Name and Address):
If there is to be storage prior to delivery to final destination, please provide the details
of the storage location here. Provide the name of the facility and a physical address.
Excess Structure
Select an Excess Structure:
Select an excess structure. The quotation that is returned to you will be less the
discount that is provided on the selected excess.
Enter the Excess Required (if Other selected above):
If you selected 'Other' above, please indicate the required excess amount (in the
currency selected above).
Loss History
Have losses been incurred on similar shipments in the last three years?
If previous insurance claims have been incurred for the type of goods for which
insurance is being sought, please indicate Yes to this question and describe the
losses below. Failure to disclose this information will result in the insurance policy
being voided from inception.
If so, please describe these losses:
Please provide details of dates, quantum and circumstances of each loss
incurred in the last three years. Failure to disclose this information will result in the
insurance policy being voided from inception.
Notes
Special Instructions / Notes about the voyage and this request:
Please provide any other pertinent information about this shipment and the request.