Proposal Forms

Company Name:

Address:

Telephone:

Fax:

E-mail:

Name of person at your company to whom correspondence should be addressed:

Insurance broker to whom quotation should be sent:

The insurance cover offered by ITIC to ship managers is based on the premise that the ship manager carries out his functions under the ship management contract "as agent for" his shipowner principal. Furthermore, the cover provided by ITIC is on terms no more onerous than the BIMCO "Shipman 98" which is the standard ship management contract world-wide.

The term "ship management" covers a wide range of activities ranging from consultancy to the performing of all the functions of a shipowner. However, unless specifically declared and agreed by the Club, only those activities performed under a specific ship management contract will be insured. We have listed below the majority of activities undertaken by ship managers and would ask you to indicate which activities are undertaken by you.

PLEASE PROVIDE SEPARATELY BY FAX OR MAIL A COPY OF YOUR STANDARD SHIP MANAGEMENT CONTRACT, OR ALTERNATIVELY, IF YOU HAVE THIS IN ELECTRONIC FORMAT, PLEASE USE THE FIELD BELOW FOR ATTACHING FILES TO THIS FORM.

1. General Information

1.1

Please list the ships under your management, with details of their age, flag, type and tonnage as well as the names of their owners and beneficial owners. Please also specify the nationality of the crew and who has supplied them. A suitable form for these purposes can be downloaded here (Word format).

Please also indicate if any of these ships are managed on behalf of banks, leasing companies, finance houses, investors (equity schemes of K/S partnerships). If so, please give details separately by fax, mail or attach with your completed Ships Under Management document below:

Attach completed Ships Under Management document: †

1.2

Do you have any financial interest in the ships under your management? yes no

1.3

Do the owners of any of the ships you manage have any financial interest in your company? yes no

2. Services

2.1 Ship management activities:

Please indicate which of the following activities you undertake for the ships you manage:

a. Technical

Vessel superintendency yes no

Arranging repairs/dry dock yes no

Obtaining class & flag approvals yes no

Arranging spares, stores & victualling yes no

Property maintenance yes no

Appointing surveyors yes no

b. Crewing

Arranging for the employment of crew "as agent for" the owner yes no

Arranging crew travel yes no

Arranging crew national insurance requirements yes no

Ensuring ITF acceptability of crew yes no

Negotiating with unions yes no

Supplying crews employed in your own name yes no

(If "Yes", please complete the separate additional form for crew managers), (In either case you will not be insured for claims by crew members or their dependants and relatives under crew employment contracts).

c. Operations

Issuing "instructions to masters" yes no

Appointing and funding of agents yes no

Issuing bill of lading yes no

(If "Yes", please attach examples) †

Liaising with charterers yes no

Arranging bunker stems yes no

(Do you re-invoice the owners for goods and services supplied, e.g. bunkers? Re-invoicing usually results in your becoming the principal and therefore directly responsible for e.g. the quality of bunkers supplied. You will not be insured if you contract as a principal).

d. Commercial Management

Arranging charterparties or contracts of affreightment yes no

Canvassing for cargoes yes no

e. Accounting

Ship husbandry accounting yes no

Voyage accounting yes no

Collection of bill of lading freights yes no

Collection of voyage freight/charterparty hire yes no

Arranging payment of bareboat or time charter hire yes no

f. Insurance

Do you place the ships' insurances? yes no

Hull yes no

P&I yes no

War yes no

Strikes yes no

Loss of hire yes no

Other yes no

2.2

Do you sub-contract the placing of the ships' insurances? yes no

2.3

Are you co-insured on the owners' insurance policies? yes no

(It will be a condition of your insurance with ITIC that you are named as co-assured on the owners' P&I and hull insurance policies)

2.4

If not co-insured, do underwriters waive their rights of recourse against you? yes no

2.5

Do you handle insurance claims against e.g. stevedores? yes no

2.6

Are the ships which you manage insured by P&I Clubs in the International Group? yes no

2.7

If not where is their P&I insurance placed?

2.8

Are the ships under your management all classed by a classification society that is a Member of the IACS? yes no

3. Income from ship management

For the purposes of underwriting all we require is a declaration of the gross annual income that you earn as a ship manager.

Gross Annual Income

a. Last financial year

b. Estimate for this financial year

c. Estimate for next financial yeae

4. Sub-contracting

4.1

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

4.2

If "Yes", do you maintain your rights of recourse for their errors and omissions? yes no

4.3

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

4.4

Do you undertake any other activities for the ships which you manage? yes no

If "Yes", please detail:

THE FOLLOWING ACTIVITIES WILL NOT BE REGARDED AS BEING THE NORMAL BUSINESS OF A SHIP MANAGER:

4.5

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

4.6

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

Please provide details:

5. General declaration

5.1

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

5.2 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

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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