SEMA Insurance

SEMA Cargo Division

Cargo Insurance Application

Applicant Name:		No. Yrs. In Business
Address:		State: Zip:
Description of Operation		Principal Commodities shipped:
How are goods packaged for import/export?		Who performs packing/unpacking?
Primary Points ofshipment From:		To:
Are Door-To-Door Containers used?		Proposed Attachment Date:
Terms of Sale:		Valuation:

Desired Coverages (Check applicable items)

	All Risks		F.P.A. (only)		War Risks		Import Duty		Contingency
	F.O.B/F.A.S		All Risks w/Deductible $				Other Please state:

Annual Volume & Per Shipment Limits Breakdown

Avg. $		Max. $		Value Per Any One Shipping Package or Container
Avg. $		Max. $		Value Per Vessel (Under-Deck)

Annual: Dolllar Vollume Shipped via Vessel

Number of Shipments

Avg. $

Max. $

Value Any One Shipment Via Air Cargo

Annual: Dolllar Vollume Shipped via Air Cargo

Number of Shipments

Avg. $

Max. $

Value Per Package Shipped Via Mail/Parcel Post

Annual: Dolllar Vollume Shipped via Mail/Parcel Post:		Number of Shipments
Total Annual Volume Shipped:$

Five Year History: Please Enclose Detailed Loss Experience

Please Upload any additional documentation i.e. Annual Reports, Brochures, etc. that may assist underwriters in their review of this account.		Allowed extensions: pdf,doc,rtf,txt,zip,ppt,xls,docx,jpg,tiff,png,gif Maximum Filesize: 10524288 bytes
Agent/Broker:		Contact:
Producer Code:		Comments:

= Required