16th May, 2008 | 14:26:41 BST

Proposal Forms

Proposal Form for Crew Managers

ITIC Ltd, International House, 26 Creechurch
Lane, London EC3A 5BA.
Tel. +44 (0)20 7338 0150 Fax +44 (0)20 7338 0151
E-mail ITIC@thomasmiller.com
Website www.ITIC-insure.com

[Download this form in Word 6/95 format]

Company Name:

Address:

Telephone:

Fax:

E-mail:

Insurance Broker:

Theinsurance offered by ITIC to crew managers covers the Member where he acts as a principal in the supply of crew to the owner. He is invariably the employer of the crew (although the owner himself may also be regarded as the employer under the laws of his flag state, or the countries to which he trades e.g., USA). The crew manager normally supplies his crew on a lump sum basis.

The supply of crew on an agency "cost plus" basis may also be insured by ITIC, but the correct form for this activity is the proposal form for ship managers.

The term "crew management" covers a range of activities from recruiting and training crews to arranging crew insurances. We have listed below most of the activities undertaken by a crew manager and would ask you to indicate which of them are undertaken by you. If you offer additional services to the owner, we would ask you to declare them specifically, as otherwise your insurance will be limited to those activities indicated.

The insurance offered by ITIC specifically excludes cover for the crew manager for claims by crew members or their dependants and relatives under their crew employment contract.

"Crew" shall mean the masters, officers and seamen detailed at paragraph 3.

"Company" shall mean the crew management company providing the services to be covered under this insurance.

"Owner" shall include a charterer, bareboat charterer and technical manager.

1. General Information

1.1

Please list the ships to which you provide crew together with details of their age, flag, type and tonnage and the number and nationality of crew allocated to each ship:

1.2

Please also declare how long you have been providing crew to each shipowner/ship:

1.3

Do you have any financial interest in the ships to which you provide a crew?: yes no

1.4

Do the owners of any of the ships to which you provide crew have any financial interest in your company? yes no

2. Services

2A Crew management activities:

Do you provide the following services:

a. Employment

Are crew employed by you directly? yes no

Or "as agent for" the shipowner? yes no

Or both the above? yes no

b. Selection

Are the crew selected by you? yes no

Or by an "in-house" manning agent/crew supplier? yes no

Or by a third party manning agent/crew supplier? yes no

Do you interview crew yourself? yes no

Do you check and verify the documentation of the crew yourself? yes no

Do you ensure that all personnel have passed a medical examination by a qualified doctor prior to the crew member leaving his country of domicile for embarkation? yes no

Are you responsible for selecting and approving the doctor? yes no

Do you arrange to test the crew for Hepatitis B, venereal diseases and AIDS? yes no

Is this testing on a routine basis? yes no

Do you have a written drug and alcohol policy? yes no

Are you responsible for ensuring that the requirements of the law of the flag state are satisfied in respect of the following?:

(aa) rank, qualification, certification and where applicable numbers of the crew: yes no

(bb) employment regulations: yes no

(cc) crew tax and social insurance requirements: yes no

2B

If you are not, please state who does have these responsibilities:

2C

Are any of the crew engaged pursuant to collective bargaining agreements requiring approval by the ITF? yes no

2D

Do you negotiate with unions? yes no

2E

Do you ensure that the standard of English for each individual crew member is adequate or sufficient to enable him/her to perform the duties that he/she is required to carry out? yes no

2F Training

Do you have a company operated training scheme? yes no

If not, do you have a thirdparty operated training scheme? yes no

2G

If "Yes" please state who is providing that training:

2H Insurance:

Do you place crew insurance for the following risks:

Death/injury yes no

Sickness yes no

Repatriation yes no

Shipwreck yes no

Unemployment yes no

Indemnity yes no

Loss of personal effects yes no

Is this insurance placed with a P&I Club in the International Group? yes no

Or a first class insurance company or underwriter: yes no

2I

Please name the Club or insurer:

2J

Is someone else responsible for placing the crew insurance (the owners for instance)? yes no

2K

If "Yes", please specify who is responsible for placing the insurance:

2L

If you place the insurance, do you ensure that the owners are co-assured on the crew insurances? yes no

2M

Do you ensure that the owners' insurances on the vessel name you as a co-assured? yes no

2N

Is the vessel insured for hull and machinery risks (including excess liabilities) on terms equivalent to the Institute Time Clauses - Hull 1/10/83? yes no

(If you place the crew insurances in your own name, there will still be a requirement to be named on the shipowners' P&I and hull policies in orderto avoid subrogated claims from those insurers. ITIC insures the negligence of the crew manager, not the negligence of the crew which is a P&I/hull matter).

2O Travel:

Do you arrange crew travel? yes no

3. Nationality and number of crew employed

3A Please state number of employees:

Masters:

Chief engineers:

Other officers:

Crew:

3B Please give a breakdown of the officers and crew by nationality:

Masters:



Crew:

4. Income from crew management

For the purposes of underwriting all we require is a declaration of the gross annual income that you earn as a crew manager. This figure is made up of the fees that you actually earn and bear no relation to the turnover (total cost of crew per ship) or profit. On average it consists of approximately 5-15% of the total cost of the crew per ship.

a. Last financial year:

b. Estimate for this financial year:

c. Estimate for next financial year:

5. Sub-contracting

5A

Do you sub-contract any of the activities which you undertake to companies that will not be shown as co-assured under your terms of entry? yes no

5B

If "Yes", on what terms do you sub-contract with these companies?

5C

Do you require these companies to have insurance for their errors and omissions? yes no

5D

Are you a member of the International Ship Managers' Association (ISMA)? yes no

5E

Have you received quality assurance certification or adopted ISMA's code of ship management standards? yes no

5F

Have any claims been made against you, or have there been any circumstances likely to give rise to a claim being made against you in the last five years? yes no

5G Has any insurer

a. Declined to insure you: yes no

b. Cancelled your insurance: yes no

c. Refused to renew your insurance: yes no

d. Imposed special terms: yes no

5H

If "Yes", please give full details:

DECLARATION

We declare that the information and answers given in this form are true to the best of our knowledge and belief and that we have not mis-stated or suppressed any material facts that might influence the Club's assessment of the risk. We also understand that completion of this form does not bind either the Club or ourselves to accept this insurance but, if terms are agreed, it will form part of our contract with the Club.

This proposal form must be completed by a person who is authorised to bind the proposer.

Name:

Position in company:

Date:

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