Loadsure — Cargo War Risks Application

Cargo War Risks — Application to Quote

Complete all sections. Fields marked ✦ are required to obtain a quotation.

Reference / Policy No.

War Product — Request to Quote

Select all war risk cover types required. Some risks may require cover for one mode only; others may require a combination.

Ocean / Sea

War risks for cargo in transit by ocean vessel

Air Cargo

War risks for cargo transported by air freight

War on Land (WoL)

Cover for cargo transiting overland through conflict zones

Multimodal

Combination of two or more transit modes under one policy

Policyholder Details

Name of Assured (Policyholder) ✦

Assured Address ✦

Country of Registration ✦ Cover available for assureds registered in the USA or EEA (including the UK).

Name of Co-Assured (if applicable)

Co-Assured Address

Cargo & Transit Details

Type of Goods / Description of Cargo ✦

Transit Origin ✦

Transit Destination ✦

Estimated Transit Date (ETD) ✦

Estimated Transit Arrival (ETA) ✦

Transit Method ✦

If by ocean vessel

Name of Vessel

Vessel IMO Number

If by truck / road

Security Measures

Convoy?

Yes No

High Risk Area (HRA) Transits

⚠

Important: War Risk premiums are materially affected by transits through designated High Risk Areas. Please answer each question accurately. Incorrect declarations may void cover.

Transit through
Red Sea HRA?

Yes No

Transit into / through
Persian Gulf HRA?

Yes No

Transit through
Strait of Hormuz?

Yes No

Policy Values & Coverage

Currency of Policy ✦

Average Value per Transit ✦

Maximum Value per Transit ✦

Estimated No. of Transits ✦

Total Expected Values to be Shipped ✦ Aggregate shipment value over the policy period.

Anticipated Storage in the Course of Transit? ✦

Yes No

Storage Details

Storage Location / Duration

Additional Comments & Declarations

Additional Comments

The Assured confirms that to the best of their knowledge and belief the information provided in this application is complete and accurate. Any material change in the risk must be reported to Loadsure immediately. This document forms the basis of the contract of insurance.

Name of Authorised Signatory ✦

Date ✦

Submitting Broker / Representative Name ✦

Broker / Representative Email ✦

Brokerage / Company Name ✦