CARRIER’S AND/OR FORWARDER’S, CARRIER’S AND WAREHOUSEMEN’S LIABILITY INSURANCE

QUOTATION  SLIP

NO. ________(New)

TYPE	:	CARRIER’S AND/OR FORWARDER’S, CARRIER’S AND WAREHOUSEMEN’S LIABILITY INSURANCE
INSURED	:	PT.  ___________________ and/or Affiliated Co. and/or Associated Co. and/or f.t.r.r.i
ADDRESS	:	To be advised
INSURANCE PERIOD	:	12 (twelve) months from the date to be advised at 12.00 noon local time (both days inclusive)
THE BUSINESS	:	Forwarding Company and/or Trucking Cargo Transporter and any other activities related thereto
INTEREST INSURED	:	All sums which the Insured shall become legally liable to pay for compensation and all cost and expenses of litigation arising out of any loss and/or damage to goods and/or other properties in the care, custody or control of the Insured sustained by Their Customers including but not limited to : Ä  While on vehicles in the ordinary course of transit (including the process of loading and unloading incidental to such transit) anywhere within the territorial limit. Ä  Stored in the warehouse or warehouses operated by the Insured Arising out of all operations and management of ________________ and/or any third party in the Insured’s services while engaged in the Insured’s business and/or trade.
TERRITORIAL LIMIT	:	All over Indonesia
LIMIT OF INDEMNITY	:	IDR./USD. _______________ of any one accident or series of accident arising out of the same event.
TOTAL LIMIT OF INDEMNITY	:	IDR./USD. ________ in any one period of insurance.

DEDUCTIBLE :

Ä  FOR PROPERTY DAMAGE ONLY :

IDR./USD. ________ for anyone loss or series of losses arising out of the same event.

Ä  BODILY INJURY & DEATH : NIL

Ä  HIJACKING :

5% of Recoverable Claim Amount with minimum IDR. __________ for any one loss or series of losses arising out of the same event due to hijacking.

EXTENSION CLAUSES :

1.       Cancellation Notice Clause (30 days)

“Both the Insurer and the Insured are entitled to terminate this insurance upon 30 (thirty) days notice in writing being given. Such termination should be effected by the registered letter and the Insured entitled to a pro-rata refund premium for the un-expired period of Insurance.”

2.       Hijacking Clause

3.       Loss Notification Clause (30 days)

4.       Loading and Unloading Clause

5.       Nominated Loss Adjusters Clause

6.       Payment on Account Clause

7.       Reinstatement Value Clause

8.       Temporary Storage Clause (30 days)

“Notwithstanding of anything contained in the Policy to the contrary, it is hereby declared and agreed that the Policy is extended to include temporary storage up to 30 days.

This extension is deemed to include cover for Loss or Damage to the subject manner caused by or arising out of Robbery, Theft or Burglary and/or fire”.

EXCLUSIONS	:	As more specified in the Policy, except conditions have been extended.
PREMIUM	:	IDR./USD. ________ per annum

SECURITY :  1^st CLASS INSURANCE COMPANY

Jakarta, ____________, …..

Signed in and on behalf of                                                                                                AGREED AND ACCEPTED BY,

……………………….