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FORM – RISK ANALYSIS

Carrier / Freight Forwarder / Warehouse Keeper

Company Information

1

Turnover Information

Field of Activity in the Previous Year:
Activity Shares of turnover % Absolute in €
Freight services (transportation turnover)
with own/leased/rented/borrowed motor vehicles
using truck sub-carriers
warehousing
customs activities
remaining freight forwarding activities
(except for truck freight brokerage)
Other activities:
TOTAL
2

Carrier activities

Shipping method
special modes of transportation
(with flat-rate indemnity limits)
3

Vehicles

Number of your own vehicles deployed in road freight transport
Covered vehicles
pcs
Vehicles with a permanent superstructure
pcs
Refrigerated vehicles
pcs
Tankers and silo vehicles
pcs
Motorised vehicles - transporters
pcs
Heavy goods vehicles / flat bed
pcs
Dump trucks
pcs
Container chassis
pcs
Other special vehicles:
4

Fleet structure

Motor vehicles Trailers Tractor units Semi-trailers
up to 4 t NL
pcs
up to 20 t NL
pcs
pcs
up to 20 t NL
pcs
4 - 6 t NL
pcs
from 20 t NL
pcs
from 20 t NL
pcs
up to 6 t NL
pcs
pcs
pcs
Self-propelled
5

Typical special equipment

6

Freight forwarder activities

Shipping method
%
%
By means of transport
%
%
%
%
%
By goods
%
%
%
%
(with flat-rate indemnity limits)
%
%
%
7

Employment of truck sub-carriers

Commissioning of
%
%
%
%
2.Sum insured per case of damage of the regular carriers
What control measures are carried out and/or what documents are obtained?
How often?
8

Storage

Type Yes No Place Solid construction Hard roofing Alarm system Window / door / roller shutter securing system Video monitoring Fire protection devices Fences company premises Entrance/exit controls
Freight forwarding and handling warehouse?
Long-term warehouse (sched. warehouse)?
Temperature-contr. warehouses?
Food storage warehouses?
Warehouses for industrial products?
External warehouses?
Other warehouses?
9

What GTCs are applied?

10

Supplementary questions in case of activities uncommon for shippers

11

Drawing up of Documents

Travel route Document Status Executing body Number p.a. Tons p.a.
Multimod. FIATA-BL
Multimod. House-BL
Air AWB
House / Agent / Airline
Sea BL
House / Agent / Shipping company
12

Customs activities

Issue of... Status Number p.a.
own dispatch notes in total
own T1 documents
own T2 documents
dispatch notes for goods subject to common market regulations (livestock, meat, meat products, cereals)
dispatch notes for consumables subject to high taxes (tobacco products, ethyl alcohol, brandy, liqueur & different spirits)
Issue of... Status Declarations p.a.
Do you use third-party T documents?
If yes, purchase against statement of commitment?
Do you perform special customs clearances?
Releases for free circulation
Customs warehouse / SCW
EUR
13

Geographic areas of application in %

Domestic Europe CIS Asia Africa Americas Australia
Carrier
Freight forwarder (+intermedi.)
Warehouse keeper
14

Types of goods in %

Type Carrier Freight forwarder Warehousing
Bulk goods
%
%
%
High-value goods (Electronics, phones, etc)
%
%
%
High-value goods (pharma, cosmetics, etc.)
%
%
%
Hazardous goods
%
%
%
Temperature-controlled goods (foods)
%
%
%
Temperature-controlled goods (pharmaceuticals etc)
%
%
%
Motor vehicles (used/new cars, trucks, motorcycles, etc.)
%
%
%
Hook load/heavy goods(in particular over 30to net weight)
%
%
%
Goods subject to common market regulations (e.g. spirits, Tobacco, etc.)
%
%
%
Goods subject to common market regulations (e.g. meat, sugar, grain, etc.)
%
%
%
Valuable items(cash,precious metals,art,docs,securities)
%
%
%
Explosive goods, weapons, ammunition, drugs
%
%
%
Removal goods, Live stock
%
%
%
Other
%
%
%
15

Supplementary questions

Do you use ferries with your trucks?
In case of cabotage transport within Germany: Do you enter into contracts with liability agreements exceeding 8.33 SDR/kg (agreements of 2 SDR/kg up to 40 SDR/kg are permitted)?
Do you hire out your vehicles and drivers, putting them at the disposal of other companies? (If yes, please send in the agreements!)
For refrigerated vehicles: Do you use temperature reporting devices?
For refrigerated vehicles: Do the vehicles have an external thermometer?
Do you transship goods?
Do you carry out transportation-related interim storage?
Do you carry out interim storage that is ordered by the customer?
Renowned regular clients?
16

Claim ratio

Year Insurer Premium Compensations paid Reserves Rate
forelast year
%
last year
%
this year
%

Important Note: The risk analysis / business description needs to be submitted both completely and truthfully with regard to the date of signature. Signing this document means that you express your acknowledgement of the correctness and completeness of the information specified above. The risk analysis / business description becomes an integral part of the contract with regard to the risk ratios and risk-relevant circumstances specified. The scope of insurance coverage is subject to the terms and conditions of the insurance contract. Any deletions, lines or other signs or non-response will be considered a negative response. Any incorrect information provided on the circumstances material to any risk or any fraudulent concealment of any other circumstances material to any risk may entitled the insurer to withdraw from the contract or to refuse insurance coverage. In any case of fraudulent misrepresentation, the insurance contract may be contested.

Wichtiger Hinweis: Die Risikoanalyse/Betriebsbeschreibung ist vollständig und wahrheitsgemäß, bezogen auf das Datum der Unterzeichnung, abzugeben. Mit der Unterschrift wird die Richtigkeit und Vollständigkeit der o. a. Angaben bestätigt. Die Risikoanalyse/Betriebsbeschreibung wird in Bezug auf die angegebenen Risikoverhältnisse und gefahrerheblichen Umstände Vertragsbestandteil. Der Umfang des Versicherungsschutzes bestimmt sich nach den Bedingungen des Versicherungsvertrages. Streichungen, Striche oder sonstige Zeichen oder Nichtbeantwortung gelten als Verneinung. Unrichtige Angaben zu den Gefahrumständen oder das arglistige Verschweigen sonstiger Gefahrumstände können den Versicherer zum Rücktritt oder zur Versagung des Versicherungsschutzes berechtigen. Im Falle arglistiger Täuschung kann der Versicherungsvertrag angefochten werden.