Open Cargo Application

Cargo Application for Importers and Exporters.
(Trucking Companies click here to apply for Motor Truck Cargo Legal Liability)
Please fill out the form, and submit it to InsureCargo. For additional information or if you have any questions, please call Sales at 1-888-286-5647 Ext. 218.
Contact Information

Name
Your relationship to the Insured Company

Phone	Fax
Email

Are you an ACE USA agent?

Insured Company Information

Company Name
Street Address 1
Address 2
City	St/Province
Country	Zip Code
Company Website
No. of years in business
Nature of the Business (Manufacturer, Distributor, Importer, Exporter, etc.)

Geographical Limits

	U.S. to World	World to U.S.	World to World
	U.S. to U.S.	Intra - Country Shipments (other than U.S.)

Valuation

Invoice, including Charges, Plus Ocean Freight, Plus 10%
Other:

Commodity

Principal Merchandise to be Insured

Packing

	Containerized	% Door to Door
	Full Less than Full

Packing (Describe in Detail)

Limits of Insurance

$	By Any One Vessel.	$	By Any One Domestic Conveyance.
$	By Any One Vessel on Deck.	$	By Any One Barge.
$	By Any One Aircraft.	$	By Parcel Post (U.S. Mail).
$	By Any One Owned / Leased Vehicle.	$	By Any One Package via Express Carrier (UPS, Fedex).

Insured Volume

Export

Import

Domestic

Past 12 Mos.

Est. Next 12 Mos.

Est. Avg. Value Per Shipment

Percent by Conveyance

Air

Vsl

Air

Vsl

Air

Trk

Gross Annual Sales

Warehousing

* Type of Construction, Burglary & Fire Protection, Age, and Square Footage.

Geography

Principal Countries to which Goods are Exported (Indicate % involved)
Principal Countries from which Goods are Imported (Indicate % involved)

Current/Expiring Policy Information


Current Insurer
Broker
Policy Expiration Date
Current Premium Rate %
Est. Annual Premium $
Current Deductible $	Desired Deductible $
Loss Information (3-Year history, Countries, Amount, Description of Loss)

Remarks

Comments

Source

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