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FORM – RISK ANALYSIS

Carrier / Freight Forwarder / Warehouse Keeper

Form - Risk Analysis

Insurance holder
Address
The Company field is required.

Carrier activities

EUR

Shipping methods in %

%
%
the total of this percentage must be 100%

Transportation Mode

%
%
%
%
%

Geographical operational areas

%
%
%
%

Types of goods

%
%
%
%
%
%
%
%
%
%
%
%
%
The total of this percentage must be 100%

Vehicles

Vehicle inventory
pcs
pcs
pcs
pcs
pcs
pcs
pcs

Fleet structure

Motor Vehicles Trailers Tractor Units Semi-trailers
up to/bis 4 t NL
pcs
up to/bis 20 t NL
pcs
pcs
up to/bis 20 t NL
pcs
4 - 6 t NL
pcs
over/über 20 t NL
pcs
over/über 20 t NL
pcs
from/ab 6 t NL
pcs
Car / Delivery Van Fork Lift Trucks Outdoor Lift manlift / Self-propelled
pcs
pcs
pcs

Typical special equipment

Supplementary Questions

1. Do you use ferries with your trucks?
2. Do you hire out your vehicles and drivers...?
3. For refrigerated vehicles: Do you use temperature monitoring devices?
4. For refrigerated vehicles: Do the vehicles have an external thermometer?
5. Do you transship goods without an order?
6. Do you carry out (transportation-related) interim storage that is not ordered by the customer?
7. For trucks with a loading crane: Are there crane activities (beyond loading and unloading of goods)?
8. Do you sign formal obligations when acquiring T-documents / supply notes?
9. Do you use general terms and conditions? Which?
10. Are there renowned clients? Which?

Other Activities

EUR
EUR
EUR
EUR

Claim Ratio

Year Insurer Premium (€) Compensations Paid (€) Reserves (€) Rate (%)
Forelast Year
Last year
This year
By submitting this form, you confirm that all information provided is accurate and complete.

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.