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Assured

Assured's Name*

Address*

Street City ZIP / Postal Code Country

Telephone*

Contact

First Name*

Last Name*

Email*

Broker

Broker Used*

Yes
No

Broker's First Name*

Broker's Last Name*

Company*

Broker's Email*

Your Trade

What is your main trade?*

I am an operator and charter vessels to sell shipping or freight to others
I use ships as a part of the supply chain only i.e I am buying or selling cargo to trade or manufacture

How many years has your company been chartering ships?*

How many vessels do you expect to charter per annum?*

What is the Gross Tonnage of the vessels you charter?*

Please mark all that apply

1 to 4,999
5,000 to 19,999
20,000 to 34,999
35,000 to 59,999
60,000 to 100,000
100,000+

Which charterparty form(s) do you use most frequently to charter vessels from head owners?*

Please mark all that apply

Time Charter such as NYPE
Time Charter such as NYPE in TCT format
Voyage charter
Baltime
Supplytime

Which charterparty form(s) do you use most frequently to charter vessels to others?*

Please mark all that apply

Back to back period or TCT format
Voyage charter
Booking Note

What types of cargo do you carry?*

Please mark all that apply

INCO terms utilised

FOB Purchase (Past 12 Months)*

Please enter a number from 0 to 100.

FOB Sale (Past 12 Months)*

Please enter a number from 0 to 100.

FOB Purchase (Next 12 Months)*

Please enter a number from 0 to 100.

FOB Sale (Next 12 Months)*

Please enter a number from 0 to 100.

CIF Purchase (Past 12 Months)*

Please enter a number from 0 to 100.

CIF Sale (Past 12 Months)*

Please enter a number from 0 to 100.

CIF Purchase (Next 12 Months)*

Please enter a number from 0 to 100.

CIF Purchase (Next 12 Months)*

Please enter a number from 0 to 100.

CFR Purchase (Prev 12 Months)*

Please enter a number from 0 to 100.

CFR Sale (Prev 12 Months)*

Please enter a number from 0 to 100.

CFR Purchase (Next 12 Months)*

Please enter a number from 0 to 100.

CFR Sale (Next 12 Months)*

Please enter a number from 0 to 100.

Other Purchase (Past 12 Months)

Other Sale (Past 12 Months)

Other Purchase (Next 12 Months)

Other Sale (Next 12 Months)

Which charterparty form(s) do you use most frequently to charter vessels from head owners

Which charterparty form(s) do you use most frequently to charter vessels to others

Where do you trade?*

Where do you trade

Do you perform to ship to ship transfers?*

Yes
No

Do you perform mixing and blending operations?*

Yes
No

Do you trade outside of ice limits (INC)?*

Yes
No

Do you execute Charterers’ bills of lading (identify yourself as carrier)?*

Yes
No

What percentage of your trade*

Please enter a number from 0 to 100.

Please give details of your current insurance*

We will ask you about your insured or uninsured claims history when we provide a quote for your business. When providing indicative terms our assumption is that the claims history is good and that the loss ratio (i.e. the comparison between premium and claims paid and outstanding) is below 30%.

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the charterers P&I club

Proposal form

If you are interested in receiving an indication of the cost of insuring vessels with The Charterers P&I Club please complete the Proposal Form below.

Assured

Contact

Broker

Your Trade

INCO terms utilised

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