the charterers P&I club About Security Cover Defence (FD&D) Insurance Liability (P&I) Insurance Terms and Conditions Claims Proposal form Correspondents Publications Team News Contact Emergency Proposal formIf 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. AssuredAssured's Name*Address* Street City ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Telephone*ContactFirst Name*Last Name*Email* BrokerBroker Used*YesNoBroker's First Name*Broker's Last Name*Company*Broker's Email* Your TradeWhat is your main trade?*I am an operator and charter vessels to sell shipping or freight to othersI use ships as a part of the supply chain only i.e I am buying or selling cargo to trade or manufactureHow many years has your company been chartering ships?*Newly established1 to 2 years2 to 5 yearsOver five yearsHow many vessels do you expect to charter per annum?*1 to 56 to 1516 to 3031 to 6061 to 100100+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 Bulk hard commodities e.g. iron ore, coal etc Bulk soft commodities e.g. wheat, barley etc Containers Persistent oils e.g. crude Non persistent oils e.g. petrol Refridgerated cargoes Breakbulk cargoes Breakbulk cargoes exceeding 50 MT or 20 M any one piece Nickel Ore Bauxite Bagged Rice Deck Cargo INCO terms utilised FOB Purchase (Past 12 Months)*Please enter a value between 0 and 100.FOB Sale (Past 12 Months)*Please enter a value between 0 and 100.FOB Purchase (Next 12 Months)*Please enter a value between 0 and 100.FOB Sale (Next 12 Months)*Please enter a value between 0 and 100.CIF Purchase (Past 12 Months)*Please enter a value between 0 and 100.CIF Sale (Past 12 Months)*Please enter a value between 0 and 100.CIF Purchase (Next 12 Months)*Please enter a value between 0 and 100.CIF Purchase (Next 12 Months)*Please enter a value between 0 and 100.CFR Purchase (Prev 12 Months)*Please enter a value between 0 and 100.CFR Sale (Prev 12 Months)*Please enter a value between 0 and 100.CFR Purchase (Next 12 Months)*Please enter a value between 0 and 100.CFR Sale (Next 12 Months)*Please enter a value between 0 and 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 ownersWhich charterparty form(s) do you use most frequently to charter vessels to othersWhere do you trade?*Where do you tradeSouth AmericaWest AfricaEast or North AfricaYemen or SomaliaIndian sub-continentAsiaAustralasiaDo you perform to ship to ship transfers?*YesNoDo you perform mixing and blending operations?*YesNoDo you trade outside of ice limits (INC)?*YesNoDo you execute Charterers’ bills of lading (identify yourself as carrier)?*YesNoWhat percentage of your trade*Please enter a value between 0 and 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%. CAPTCHA CONTACT DROP US A LINE SEND MESSAGE
