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Policy Type Do you want to * Buy New Policy Renew Existing Policy Previous Policy Issued By Select a Company ICICI Lombard Bajaj Allianz TATA AIG Reliance General Cholamandlam MS IFFCO-TOKIO Royal Sundaram New India Assurance National Insurance United India Oriental Insurance HDFC Ergo Previous Policy End Date

General Name of Assured * Contact Person Address1 Address2 City State/Province --Select State-- Andaman and Nicobar Andhra Pradesh Arunachal Pradesh Assam Bihar Chandigarh U.T. Chhattisgarh Dadra and Nagar Haveli Daman and Diu Delhi Goa Gujarat Haryana Himachal Pradesh Jammu and Kashmir Jharkhand Karnataka Kerala Lakshadweep U.T. Madhya Pradesh Maharashtra Manipur Meghalaya Mizoram Nagaland Orissa Pondicherry U.T. Punjab Rajasthan Sikkim Tamil Nadu Tripura Uttar Pradesh Uttaranchal West Bengal Country Zip/Postal Code E-mail * Phone No. * Nature of Business * Manufacturing Trading Others Commodity Details * ----Select Commodity---- Aircraft, Spacecraft, And Parts Thereof Aluminum And Articles Thereof Animal Or Vegetable Fats And Oils And Their Cleavage Products; Prepared Edible Fats; Animal Or Vegetable Waxes Arms And Ammunition; Parts And Accessories Thereof Articles Of Apparel And Clothing Accessories, Knitted Or Crocheted Articles Of Apparel And Clothing Accessories, Not Knitted Or Crocheted Articles Of Iron Or Steel Articles Of Leather; Saddlery And Harness; Travel Goods, Handbags And Similar Containers; Articles Of Gut (Other Than Silkworm Gut) Articles Of Stone, Plaster, Cement, Asbestos, Mica Or Similar Materials Base Metals Nesoi; Cermets; Articles Thereof Beverages, Spirits And Vinegar Carpets And Other Textile Floor Coverings Ceramic Products Cereals Clocks And Watches And Parts Thereof Cocoa And Cocoa Preparations Coffee, Tea, Mate And Spices Copper And Articles Thereof Cork And Articles Of Cork Cotton, Including Yarns And Woven Fabrics Thereof Dairy Produce; Birds Eggs; Natural Honey; Edible Products Of Animal Origin, Nesoi Edible Fruit And Nuts; Peel Of Citrus Fruit Or Melons Edible Preparations Of Meat, Fish, Crustaceans, Molluscs Or Other Aquatic Invertebrates Albuminoidal Substances; Modified Starches; Glues; Enzymes Edible Vegetables And Certain Roots And Tubers Electrical Machinery And Equipment And Parts Thereof; Sound Recorders And Reproducers, Television Recorders And Reproducers, Parts And Accessories Essential Oils And Resinoids; Perfumery, Cosmetic Or Toilet Preparations Explosives; Pyrotechnic Products; Matches; Pyrophoric Alloys; Certain Combustible Preparations Fish And Crustaceans, Molluscs And Other Aquatic Invertebrates Footwear, Gaiters And The Like; Parts Of Such Articles Furniture; Bedding, Cushions Etc.; Lamps And Lighting Fittings Nesoi; Illuminated Signs, Nameplates And The Like; Prefabricated Buildings Furskins And Artificial Fur; Manufactures Thereof Glass And Glassware Headgear And Parts Thereof Impregnated, Coated, Covered Or Laminated Textile Fabrics; Textile Articles Suitable For Industrial Use Inorganic Chemicals; Organic Or Inorganic Compounds Of Precious Metals, Of Rare-Earth Metals, Of Radioactive Elements Or Of Isotopes Iron And Steel Knitted Or Crocheted Fabrics Lac; Gums; Resins And Other Vegetable Saps And Extracts Lead And Articles Thereof Live Trees And Other Plants; Bulbs, Roots And The Like; Cut Flowers And Ornamental Foliage Made-Up Textile Articles Nesoi; Needlecraft Sets; Worn Clothing And Worn Textile Articles; Rags Manmade Filaments, Including Yarns And Woven Fabrics Thereof Manmade Staple Fibers, Including Yarns And Woven Fabrics Thereof Manufactures Of Straw, Esparto Or Other Plaiting Materials; Basketware And Wickerwork Meat And Edible Meat Offal None Milling Industry Products; Malt; Starches; Inulin; Wheat Gluten Mineral Fuels, Mineral Oils And Products Of Their Distillation; Bituminous Substances; Mineral Waxes Miscellaneous Articles Of Base Metal Miscellaneous Chemical Products Miscellaneous Edible Preparations Miscellaneous Manufactured Articles Musical Instruments; Parts And Accessories Thereof Natural Or Cultured Pearls, Precious Or Semiprecious Stones, Precious Metals; Precious Metal Clad Metals, Articles Thereof; Imitation Jewelry; Coin Nickel And Articles Thereof Nuclear Reactors, Boilers, Machinery And Mechanical Appliances; Parts Thereof Oil Seeds And Oleaginous Fruits; Miscellaneous Grains, Seeds And Fruits; Industrial Or Medicinal Plants; Straw And Fodder Optical, Photographic, Cinematographic, Measuring, Checking, Precision, Medical Or Surgical Instruments And Apparatus; Parts And Accessories Thereof Ores, Slag And Ash Organic Chemicals aper And Paperboard; Articles Of Paper Pulp, Paper Or Paperboard Pharmaceutical Products Photographic Or Cinematographic Goods Plastics And Articles Thereof Preparations Of Cereals, Flour, Starch Or Milk; Bakers Wares Preparations Of Vegetables, Fruit, Nuts, Or Other Parts Of Plants Prepared Feathers And Down And Articles Thereof; Artificial Flowers; Articles Of Human Hair Printed Books, Newspapers, Pictures And Other Printed Products; Manuscripts, Typescripts And Plans Products Of Animal Origin, Nesoi Pulp Of Wood Or Other Fibrous Cellulosic Material; Recovered (Waste And Scrap) Paper And Paperboard Railway Or Tramway Locomotives, Rolling Stock, Track Fixtures And Fittings, And Parts Thereof; Mechanical Etc. Traffic Signal Equipment Of All Kinds Raw Hides And Skins (Other Than Furskins) And Leather Residues And Waste From The Food Industries; Prepared Animal Feed Rubber And Articles Thereof Salt; Sulfur; Earths And Stone; Plastering Materials, Lime And Cement Ships, Boats And Floating Structures Silk, Including Yarns And Woven Fabrics Thereof Soap Etc.; Lubricating Products; Waxes, Polishing Or Scouring Products; Candles Etc., Modeling Pastes; Dental Waxes And Dental Plaster Preparations Special Classification Provisions, Nesoi Special Import Reporting Provisions, Nesoi Special Woven Fabrics; Tufted Textile Fabrics; Lace; Tapestries; Trimmings; Embroidery Sugars And Sugar Confectionery Tanning Or Dyeing Extracts; Tannins And Derivatives; Dyes, Pigments And Other Coloring Matter; Paints And Varnishes; Putty And Other Mastics; Inks Tin And Articles Thereof Tobacco And Manufactured Tobacco Substitutes Tools, Implements, Cutlery, Spoons And Forks, Of Base Metal; Parts Thereof Of Base Metal Toys, Games And Sports Equipment; Parts And Accessories Thereof Umbrellas, Sun Umbrellas, Walking-Sticks, Seat-Sticks, Whips, Riding-Crops And Parts Thereof Vegetable Plaiting Materials And Vegetable Products, Nesoi Vegetable Textile Fibers Nesoi; Yarns And Woven Fabrics Of Vegetable Textile Fibers Nesoi And Paper Vehicles, Other Than Railway Or Tramway Rolling Stock, And Parts And Accessories Thereof Wadding, Felt And Nonwovens; Special Yarns; Twine, Cordage, Ropes And Cables And Articles Thereof Wood And Articles Of Wood; Wood Charcoal Wool And Fine Or Coarse Animal Hair, Including Yarns And Woven Fabrics Thereof; Horsehair Yarn And Woven Fabric Works Of Art, Collectors Pieces And Antiques Zinc And Articles Thereof Other Commodity     Commodity Type * New Commodity Second Hand Transit Type Inland Transit Overseas Transit Exports Imports Whether custom duty cover Yes No Cover Type * Open Policy Specific Cover Turnover Policy

Transportation Details Mode of Shipment * Select Mode of Shipment Air Courier Land Parcel Post Sea All (Air,Sea,Rail,Road, Courier, Post) Containerised * Yes No Packing * Select Packing Bag - Paper Bag - Plastic Bags and sacks Bales Packing Bare/Bulk Break-bulk (Containerized / non refrigerated) Break-bulk (Containerized / Refrigerated) Bulk - On Deck Bulk - Under Deck Bulk Containerized Liquids Bundle Cardboard boxes - double wall corrugated Cardboard boxes - Palletized Cardboard boxes - Palletized & shrink wrapped Cardboard boxes - single wall corrugated Cargo in Bulk Carton Box Coil Crates Drums - Fibreboard Drums Drums - Metal Drums - Plastic Drums on pallets FCL- Container Fibreboard Gaylords on pallets In customary packing In standard export packing In standard export packing - shipped underdeck unl Isotank Jute bags Jute bags on pallets Jute bags on pallets with protective wrapping LCL - Container LCL- Break Bulk More than Three ply paper bags / Non-shrink wrappe More than Three ply paper bags with protective lin Others Pallet Paper Carton Plastic bags - woven 2 ply Plastic bags - woven on pallets Plastic bags - woven single ply Plastic bags / Shrink wrapped on pallets Roll Solid plastic bags - loose Solid plastic bags on pallets Super Sacks - Break-bulk Super Sacks - Containerized Three ply paper bags Three ply paper bags shrink wrapped or palletized Two ply paper bags Two ply paper bags (shrink wrapped on pallets) Wooden Cases Wooden Cases on pallets Wooden Cases with protective wrapping Wooden Crates - contents exposed Wooden Crates - with protective wrapping From-Country/Region Select From-Country/Region India Abkhazia Afghanistan Akrotiri and Dhekelia Åland Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Denmark Djibouti Dominica East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue See Korea Norfolk Island Northern Cyprus Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa See Korea South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Togo Tokelau Tonga Transnistria Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, United States Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Any where in India Any where in World Others To-Country/Region Select To-Country/Region India Abkhazia Afghanistan Akrotiri and Dhekelia Åland Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Denmark Djibouti Dominica East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue See Korea Norfolk Island Northern Cyprus Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa See Korea South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Togo Tokelau Tonga Transnistria Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, United States Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Any where in India Any where in World Others Limit Per Consignment (Rs) *   Limit At Any Location (Rs.) Transshipment * Via Tranship None Via/Transhipment From-City To-City Amount Insured * Currency Type * Indian Rupee Euro USD

Other Details Annualised Estimated Turnover   Excess opted per Policy   Insurance Claims for last 3 years % to premium Year Losses* Paid* Outstanding Deductible applied? Select Year 2006 2007 2008 2009 2010 Yes   Amount No Select Year 2006 2007 2008 2009 2010 Yes   Amount No Select Year 2006 2007 2008 2009 2010 Yes   Amount No

Term Of Cover (Basis Of Valuation) * CIF FOB FOR C & F Invoice Value (+ overheads 10%) Others (Please Specify)

Add on Cover Loading Cover Required Not Required Liquid Cargo Container cover Required Not Required Extension for storage risk at port (in Days)        Tentative Rate you are looking for          Insurance Companies preference, if any ICICI Lombard Bajaj Allianz TATA AIG Reliance General Cholamandlam MS IFFCO-TOKIO Royal Sundaram New India Assurance National Insurance United India Oriental Insurance HDFC Ergo Notes/Comments, if Any