CARGO HANDLING QUESTIONNAIRE

1. NAME & ADDRESS: Please list the name and also provide brochure / web site or other
marketing information.

2. LOCATION(S): Please list the address of your location(s).

3a. SERVICES: Types of operation performed by you (please tick those relevant to you):-

Stevedoring; Local collection and delivery;

Marine terminal operator; Depot operator;

Container/trailer freight station; Equipment repair/refurbishment;

Container/trailer storage Waste disposal;

Inland Clearance Depot(ICD); Advice to other operators;

Airfreight terminal/depot; Operating a chassis pool;

Warehousing; Security (e.g. Police);

Emergency (e.g. Fire); Bunkering;

Other(please specify and give details);

Are any services subcontracted out?

Yes (specify which) No

3b. SERVICES – WAREHOUSING

Only answer this part of the question if you provide warehousing or storage of any cargo (other
than containerized cargo):

● What is your responsibility for the cargo stored?

● No Responsibility (if YES, please move to Question 4) Yes No

● Responsible only for maintenance of the warehouse building, fire

prevention within the warehouse and warehouse security? Yes No

● Responsible for care, custody and control of all cargo, but no

responsibility for force majeure? Yes No
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 ● Responsible for care, custody and control of all cargo, including
responsibility for force majeure? Yes No

● Please provide estimated maximum value of goods stored at any one time:
USD

● What % of your total revenue is generated by warehousing operations? %

● Do all warehouses have sprinklers and fire detection systems? Yes No

If NO, please attach details of your fire detection measures.

● Is there a fire main throughout the site? Yes No

● Is there an emergency fire pump or suitable reserve power supply to Yes No

ensure there is fire fighting water at all times?

4. CONTRACTS/INDEMNITIES

a) Contracts with Customers (for example shipping lines):

Do you have any of the following contracts with your customer(s)? And if so, please
indicate the extent of any liability for your negligence (please tick the relevant box):-

Limited liability Unlimited liability No liability Other

iro negligence iro negligence

Standard contracts?; Y N Y N Y N Y N

Individual user agreements?; Y N Y N Y N Y N

Port tariff/act/bylaws? Y N Y N Y N Y N

No contracts?;

If “Other” is ticked, please give details.

b) Other Contracts:
Have you indemnified another person for his negligence under any agreement (e.g. for
equipment, land or buildings)? Yes No
If yes, please give details separately.

Have you waived rights of recourse against another person? Yes No

If yes, please give details separately.

c) Subcontractors:
Is there a requirement in your contract with subcontractors that they have adequate
liability and property insurance? Yes No

If yes, what is the minimum limit that you require? USD

Do you check annually that all subcontractors maintain and renew their insurance?
Yes No

Note: There is a policy requirement that your Subcontractors purchase and maintain
adequate liability and property insurance, and that you review those policies annually

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5. Volumes – Please advise Cargo throughputs per Policy Year:

LAST YEAR CURRENT YEAR NEXT YEAR

ESTIMATE
TEU’s
Break Bulk (tones)
Dry Bulk (tones)
Wet Bulk (tones)
Autos
Passengers
Others (specify below)

What is your annual revenue?

LAST YEAR CURRENT YEAR NEXT YEAR ESTIMATE

How many vessel calls per annum? Please provide figures broken down into size of vessel:-

LAST YEAR CURRENT YEAR NEXT YEAR ESTIMATE

Up to 5,000 GT
5,000 to 15,000 GT
Over 15,000 GT

6. LOSS PREVENTION / RISK MANAGEMENT:

a) Do you have a property and equipment maintenance programme

Yes No

b) Do you have a staff training programme Yes No

c) Do you security precautions include:

24 hour security guards? Yes No

All buildings/perimeter fences/gates alarmed? Yes No

Close Circuit TV? Yes No

Continual documentation security checks? Yes No

Other? Please attach details Yes No

d) can you provide us with a copy of a recent survey of your facilities?

Are there any revisions to the loss prevention / risk management

measures in a) to c) above envisaged / planned during the policy period? Yes No

If yes, please attach details.

g) Is the International Ship & Port Facility Security Code applicable to you
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 and if so are you compliant. Yes No

7. HANDLING EQUIPMENT – Please provide the aggregate value for the current year and
next year and attach a schedule showing against each item, description, value and
age.

Are your declared values based on:-

New replacement value? Yes No

Market value? Yes No
Depreciated (book) value? Yes No

Please provide your estimated Maximum Possible Loss. USD

8. PROPERTY –

a) Please provide a summary of property values broken down as follows:-

SUM INSURED US$

Wharves, Quays and Jetties
Buildings
Warehouse/Storage Facilities

b) Please also attach a full schedule with description, values, age, location including details of
construction and details of fire extinguishing appliances / sprinklers;

c) Please itemize separately (together with the location) any single structure where the insured
value is in excess of USD 15,000,000;

d) Please itemize separately (together with location) any property outside the confines of the port;

Please provide your estimated Maximum Possible Loss. USD

9. CLAIMS HISTORY – Please attach separate Liability claims history (both paid and
outstanding and any related fees or expenses including legal fees) for the last 5
complete years net of any deductible and advise of any deductible applicable. Please
also attach details of any existing litigation.

Signed ………………………….…………… Date ………………………….

Company Position…………………………

IMPORTANT:
This questionnaire is to be completed and signed by the Assured and will form
part of the Insurance Policy.

The premium charged and the conditions of this Policy are based upon the
information provided in this questionnaire, any operations and/or physical
changes in the nature of the Assured’s Operations during the policy period which
materially changes or alters in any way the information contained in this

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questionnaire must immediately be advised to Underwriters. Any change advised
will be assessed by Underwriters to enable them to decide whether they are
prepared to continue to provide coverage and at what terms. Failure to comply
with this requirement could affect the validity of the Policy.

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