Livestock Imports/Exports Questionnaire - Zurich ?· Livestock Imports/Exports Questionnaire Page 1…
Post on 06-Aug-2018
Livestock Imports/Exports Questionnaire Page 1 of 3
Zurich Australian Insurance Limited ABN 13 000 296 640, AFS Licence No. 232507. 5 Blue Street North Sydney NSW 2060.
Completing the Questionnaire form1. This questionnaire must be completed in full including all required attachments.
2. If more space is needed to answer a question, please attach a separate sheet with details.
3. The terms Insured, whenever used in this questionnaire shall mean the insured and all subsidiary companies of the Insured for which coverage is proposed.
Non-disclosure or MisrepresentationIf you make a misrepresentation to us, or if you do not comply with your duty of disclosure and we issue your policy with terms and conditions that are different to the terms and conditions that would have been issued had there not been any misrepresentation, or your duty of disclosure had been complied with, then:
we may reduce the cover provided so that we are placed in the same position as we would have been in, had there not been any misrepresentation and your duty of disclosure had been complied with; and
we may also cancel your policy; or
we may treat your policy as if it never existed if the misrepresentation or your non-compliance with your duty of disclosure was fraudulent.
Duty of DisclosureThis contract of insurance will be governed by either the Insurance Contracts Act 1984 (Cth) or the Marine Insurance Act 1909 (Cth).
Duty of Disclosure under the Insurance Contracts Act 1984Before you enter into a contract of general insurance with us, you have a duty under the Insurance Contracts Act 1984 (Cth) to disclose to us every matter you know, or could reasonably be expected to know, is relevant to our decision whether to insure you and, if so, on what terms. This applies to all persons to be covered under this contract of insurance.
You have the same duty to disclose those matters to us before you renew, extend, vary or reinstate a contract of general insurance. This duty however, does not require disclosure of a matter that:
diminishes the risk to be insured;
is of common knowledge;
we know or in the ordinary course of our business we ought to know;
we indicate to you that we do not want to know.
Duty of Disclosure under the Marine Insurance Act 1909Your attention is drawn to Sections 23 to 27 of the Marine Insurance Act 1909 (Cth) and, in particular, that any contract of marine insurance is based on utmost good faith and in the absence of such good faith, may be avoided. Further, you have an obligation to disclose to us every material circumstance which is known to you and/or which in the ordinary course of business ought to be known to you. Every circumstance is material if it would influence the judgement of a prudent insurer in fixing the premium or determining whether they will take the risk. If there is a failure to make such disclosure, we may avoid the contract.
PrivacyZurich is bound by the Privacy Act 1988 (Cth). Before providing us with any Personal or Sensitive Information (Information), you should know that:
We collect, use, process and store Personal Information and, in some cases, Sensitive Information about you in order to comply with our legal obligations, assess your application and, if your application is successful, to administer the products or services provided to you, to enhance customer service and/or product options or manage a claim (purposes).
If you do not agree to provide us with the Information, we may not be able to process your application, administer your policy or assess your claims.
By providing us or your intermediary with your Information, you consent to our use of this Information which includes us disclosing your Information where relevant for the purposes, to your intermediary, affiliates of the Zurich Insurance Group Ltd, other insurers and reinsurers, our service providers, our business partners or as required by law within Australia or overseas.
Zurich may obtain Information from government offices and third parties to assess a claim in the event of loss or damage.
Livestock Imports/Exports Questionnaire Page 2 of 3
Animals to be insured
Type/Breed Age at date of shipment?
Reason for shipment (eg. breeding or slaughter)
Are animals pregnant? Yes No If 'Yes', how many months at date of shipment
Total insured value of shipment $
1. Single Shipment? Yes No If 'No', how many shipments?
2. Commencement date of cover / /
3. Where is cover to commence?
3.1 on loading for transit at farm property? Yes No If 'Yes', go to Q4
3.2 on arrival at quarantine location? Yes No If 'Yes', go to Q5
3.3 on loading for transit at quarantine location? Yes No If 'Yes', go to Q6
3.4 at port of loading? Yes No If 'Yes', go to Q8
3.5 on loading onto overseas conveyance? Yes No If 'Yes', go to Q9
4. Location of farm property
5. Date of arrival at quarantine location / / Number of days in quarantine
6. Quarantine location
7. Date of departure from quarantine / / Conveyance used
8. Date of arrival at port of loading / / Number of days at port
9. Overseas voyage
Port of loading
Estimated date of departure / /
Port of discharge
Estimated date of arrival / /
Transhipment details if applicable
Name of vessel/aircraft type
10. Where is cover to terminate?
10.1 on discharge from vessel? Yes No If 'Yes', go to next section
10.2 on arrival at holding quarantine location? Yes No If 'Yes', answer Q11
10.3 on completion of holding quarantine period? Yes No If 'Yes', answer Q11 and 12
10.4 on arrival at property at final destination? Yes No If 'Yes', answer Q11, 12, and 13
11. Holding quarantine location
Date of arrival at quarantine location / / Conveyance used
12. Period to be covered at holding quarantine location From / / To / /
13. Final destination
Date of arrival at final destination / / Conveyance used
14. Will an Australian stockman be accompanying the livestock for the duration of the transit? Yes No
Livestock Imports/Exports Questionnaire Page 3 of 3
Business and claims experience
Previous experience of Insured in the shipping, import or export of livestock
Please detail losses incurred (whether insured or not) in the import or export of livestock over past 5 years
Print FormSave File
DeclarationI/We authorise Zurich Australian Insurance Limited to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service.
I/We declare that I/we have read and understood the duty of disclosure, non disclosure and policy conditions contained herein and confirm that no information has been withheld which could affect the acceptance of this application.
Cover is specified in Zurich's Livestock Clauses. Please specify any other clause requirement/extension of cover required
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