Cargo Insurance Renewal Survey

What is your full name?(Required)

What is the full legal name of your company?(Required)

What is your renewal date?(Required)

This was provided in the email you received.

Email Address(Required)

Contact Phone(Required)

Product Classification

Select Your Primary Commodity Classification:(Required)

Apparel, Leather and Textiles(Required)

Appliances(Required)

Bathroom(Required)

Beauty and Health Products(Required)

Beverages(Required)

Building Materials(Required)

Chemicals(Required)

Cleaning Products(Required)

Consumer Goods(Required)

Electronics, Electrical Equipment/Components(Required)

Flowers(Required)

Foodstuff(Required)

Furniture and Fixtures(Required)

Kitchen Items(Required)

Knives, Blades and Razors(Required)

Machinery(Required)

Medical, Scientific, and Precision Instruments(Required)

Metal Articles and Items(Required)

Paper, Paperboard, or Printed Materials(Required)

Pet Related Items(Required)

Plastics and Rubber(Required)

Playground Equipment(Required)

School Supplies(Required)

Sporting Goods(Required)

Tools and Hardware(Required)

Transportation Equipment(Required)

Wood Products, Logs, and Other woods in the rough(Required)

Other(Required)

Please provide a detailed description of the goods to be shipped.

Upcoming Valuations

Values should be as close as possible. On the LEFT please enter values for the last 12 months. On the RIGHT please enter values for the next 12 months.

Total Value Shipped by Vessel LAST 12 months:(Required)

Enter 0 (zero) if none.

Value to be Shipped by Vessel NEXT 12 months:(Required)

Enter 0 (zero) if none.

Total Value Shipped by Air LAST 12 months:(Required)

Enter 0 (zero) if none.

Value to be Shipped by Air NEXT 12 months:(Required)

Enter 0 (zero) if none.

Total Value Shipped by U.S. Postal Service LAST 12 months:(Required)

Enter 0 (zero) if none.

Value to be Shipped by Postal Service NEXT 12 months:(Required)

Enter 0 (zero) if none.

Total Values Shipped Domestically Last 12 months:(Required)

Enter 0 (zero) if none.

Values to be Shipped Domestically NEXT 12 months:(Required)

Enter 0 (zero) if none.

Where are you shipping from and to? Add (+) & Complete a new row for each origin/destination that apply.(Required)

Shipped From

Shipped To

How are goods being shipped?(Required)

Please select all that apply

If Other, please explain.(Required)

Coverage Elections

Maximum Limit requested PER ANY SINGLE Postal Delivery:(Required)

Other(Required)

Maximum Limit requested PER ANY SINGLE Vessel or Airplane:(Required)

Other(Required)

Maximum Limit requested per any single Domestic Transport:(Required)

Other(Required)

Unnamed 3rd party warehouse coverage:(Required)

This provides coverage up to the requested limit for inventory at any unnamed 3rd party warehouse. This does not apply to any location that you occupy or that you hold a lease on. It does apply to 3rd party warehouses and 3rd party logistic operation.

Shipping to or from any of the following countries?(Required)

Afghanistan, Cuba, Iran, Iraq, Jordan, Kenya, Lebanon, Libya, Nigeria, North Korea, Pakistan, Republic of Yemen, Somalia, Sudan, Syria, Russia, the Commonwealth of Independent States (C.I.S.) and countries that formerly comprised the U.S.S.R.)

Additional Coverages

Do you have a location with more than $50,000 in inventory that you would like coverage for?(Required)

Inventory Locations(Required)

Street Address

Zip Code

Name of Location

Inventory Value

Occupancy

Fire Protection

Theft

Have there been any changes in your operation in the last 12 months?(Required)

How has your operation changed in the last 12 months?(Required)

Please include any changes in address, nature of your operation, new commodities being shipped.

Cargo Insurance Renewal Survey

Cargo Renewal Survey

Product Classification

Upcoming Valuations

Coverage Elections

Additional Coverages