Goods In Transit Insurance Proposal Form
 
  Please select the country/city where the form is to be submitted
1. Full name of the Proposer
2. Address
Tel No. Fax No. E-mail Address
                 
3. State Your Business Occupation :
4. Nature of Goods
5. Where goods are conveyed by vehicles belonging to or controlled by you, State
Registration Marks of Vehicle. Sum Insured
per Vehicle per Trailer

N.B. THE SUMS INSURED SHOULD BE REVIEWED EVERY TO CHECK THEIR ADEQUACY
6.

Will all carrying be restricted to your own vehicles?
If 'NO' , i.e. contractors are employed, state:
(a) maximum value of any one consignment
(b) maximum value of property in any one vehicle
(c) estimated total value of property in transit in the year





7. State localities where vehicles will be used
8. Are your own loaded vehicles garaged overnight?
if YES'' state :
(a) maximum number garaged in any one building
(b) Address of the building

9. Are the vechiles fitted with alarms or immobilizers?

if 'NO' state the precautions taken to protect property when vehicles are left unattended
10.
State cover required by checking the appropriate box below
Fire and Theft Only All Risks
11. Have you ever applied or been insured for Goods in Transit insurance?
12.
Please state the name of Present
(a) motor insurer if you use your own vehicles for the transits
(b) insurer for other Accident insurances
13. Have you ever made a claim for,or suffered loss by fire, theft or accidental loss or damage ?
If 'YES' please give details
     
Please complete the declaration below :
Declaration
I/We declare that :
I am / We are not at present insured with this or any other Insurer for the insurance now proposed.
No Insurer has ever cancelled or refused to renew any insurance or declined to insure me / us or required special terms.
If any of these statements do not apply please give brief reasons here:
To the best of my/our Knowledge and belief the answers given in this proposal are true and complete and if any answers have been given by any person than myself / ourselves that person shall be my / our agent for that purpose.
No material fact has been omitted.
I / We agree that this proposal and declaration shall be the basis of the contract between me / us and Compagnie Libanaise d'Assurances s.a.l
I / We will accept a policy in the form issued by the Company for the insurance now proposed.
N.B. Your insurance does not start until cover has been confirmed

 

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