PROPOSAL FORM FOR GOODS IN TRANSIT INSURANCE
DownLoad Proposal Form
(Personal Information)
Full Name Address(In Full)
Trade or Business Location of Residence
Insurance Required From     To
General Questions
State    
Geographical Area of carriage or despatch Area in which the vehicles operate in the ordinary course of business
Please Tick if any of the following will be carried or despatched
Tobacco or Cigarette
Wine or Spirit
Non Ferrous Metals
Nature and Description of goods carried or despatched
3)Will all your loaded vehicles be placed in a locked or attended garage at night? Yes No
Give details of any locking or anti-theft devices fitted to your vehicles
Give details of any locking or anti-theft devices fitted to your vehicles and state which one is placed within the 4 location below
Cab Boot
Others Others
GOODS DETAIL
 
Vehicle Registration Number Make of Vehicle
Type of Body Year of manufacture

Maximum Carrying Capacity		 Cab and Body be completely locked?
Liscence Commercial Vehicle Type of Transportation

Vehicle Trailer

Sum Insured(Maximum Value)    
For goods sent by Road,Carrier,Rail,Post or Inland Waterway State:

Estimated total of goods sent in one year =N=		 Limit to apply in respect of any load or consignment =N=
Select means of sending goods:  
Road Carrier Rail Post Others                
INSURANCE DETAIL
Do you have other insurance with the company?
 Yes No
2)Has any insurer ever
Declined to insure you? Yes No
ii)Increase your premium? Yes No    
iii)Required special terms to insure you? Yes No  
iv)Cancelled or refused to renew your policy Yes No    
If yes to any of (1) or (2) then give details
Give details of losses and damages in respect of goods in transit during the last three years:
Year    
Fire  
Number of Fire Occurences Cost of Damage
Theft    
Number of Theft Occurences Cost of Theft
Damage    
Number of Micellaneous Damages Cost of Damages
Claims Outstanding    
Nature of Claims Cost of Claims
Are there any additional facts likely to affect the proposed insurance which should be disclosed to underwriters? Yes No
If Yes, give details