APPLICATION FOR SHIP REPAIRERS' LEGAL LIABILITY
INSURANCE
Please answer all questions using block capitals
1.
Name and address of applicant:
2.
Address(es) of ship repair yard(s):
3.
Number of years in ship repair business under present management:
4.
Number of employees:
5.
Please attach brief information about the number of years' ship repairing experience of principals
(a) Full Time
(b) Part Time
and senior operation personnel.
1
6.
Percentage of annual ship repairing gross receipts generated by repair of vessels with hulls made
of:
(a) Steel:
%
(b) Wood:
%
(c) Others specify hull material:
7.
%
Type of work performed:
Hull (non - "Hot Work")
%
Engine
%
Welding/burning/"Hot Work"
%
Boiler
%
Painting/Scraping/Sandblastin
%
Electrical
%
g
Other:
8.
%
Do you do ship conversion/reconstruction work?
YES
NO
If “Yes”, what percentage of annual ship repairing gross receipts does this
account for?
9.
%
Please advise the following information for each type of vessel worked on:
Type of Vessel
No of Vessels
Average /
% of annual GR
worked on
Maximum Vessel
generated by work
Value *
on each Vessel
Type
%
%
%
2
* Put down length and G.R.T. if values not known.
10.
Number of Vessels in yard at any one time:
Yard Location
Average No. Vessels in Yard
Maximum No.Vessels Yard can
Accommodate
11.
Are any vessels repaired under cover of a repair shed or other shelter?
YES
NO
YES
NO
YES
NO
YES
NO
If "Yes", what is the published fire and E.C. rate?
12.
Do you employ, or subcontract in, divers to do work underwater?
If “Yes”, how often?
13.
Do you ever do work on navy vessels involving the firing or testing of
weapons systems?
14.
Does your work ever involve lifting and/or moving vessels using cranes,
hoists etc.?
If “Yes”, please advise:
(a)
How many times a year?
(b)
Lifting capacity of each crane?
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15.
(a)
Are gas-freeing operations performed at your yard(s)?
YES
NO
(b)
If "yes", do your own employees or outsiders perform gas-freeing
YES
NO
YES
NO
certification work?
(c)
If outsiders do gas freeing, do you have any contractual liabilities
related thereto?
(d)
If your own employees do gas freeing work, please attach a list of their names, professional
qualifications and experience.
(e)
16.
How many gas freeings are done annually?
Within how many kilometres of the yard are following operations performed?
(a)
Vessel Tests/Trials:
(b)
Vessel movements in connection with repair
kilometres.
operations.
(Such as from one repair pier to another):
(c)
kilometres.
Describe the extent of any assumed contractual liabilities arising out of vessel movements,
tests or trials:
17.
(a)
Describe the nature of any repairs carried out away from the yard:
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(b)
Describe the extent of any assumed contractual liabilities arising out of vessel movements,
tests or trials:
(c)
What percentage of your total annual ship repairing gross
receipts does this account for?
18.
%
Do you do any work on vessels that is not repair, reconstruction or
conversion work?
YES
NO
If "Yes", describe the nature of such work, and note the value of gross receipts it generates:
19.
(a)
How close is the nearest Public Fire Department Station?
kilometres.
(b)
Is Public Fire Department paid, or volunteer?
(c)
Please note the number of fire hydrants and their proximity to your yard:
(d)
Describe fully all private fire protection facilities available, including number of hand-held
fire extinguishers and the nature of any sprinkler system:
5
20.
21.
(a)
Is yard fenced?
YES
(b)
Describe nature of security measures, including watchmen:
NO
Please enclose copies of any property and/or liability insurance surveys done at your yard within
the past 18 months, plus diagrams or maps of the yard lay out.
22.
Please enclose a copy of your standard contract terms, and any contracts extending your
contractual liabilities beyond the terms of your standard contract.
23.
Please note what percentage of your total ship repairing gross receipts from work:
(a)
Sub-contracted in
%
(b)
Sub-contracted out
%
Please provide full copies of all sub-contracts entered into.
24.
Please provide details of your annual gross receipts for the last 7 years:
Year
Annual Gross Receipts
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25.
Estimated gross receipts for the next 12 months:
26.
Please provide details of all ship repairing losses, insured or not, for the last 7 years:
Date of Loss
Amount of Loss*
Status of Loss (i.e.
Brief description of circumstances
before application
if paid or reserved
surrounding Loss
of any deductible
27.
Limit of liability insurance required:
28.
Current insurer:
29.
Current insurance broker:
30.
Has any insurer ever cancelled or refused to renew your insurance?
YES
NO
If “Yes”, please explain:
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31.
When does your current insurance expire?
I understand that the above information and supplemental information enclosed, which is correct
to the best of my knowledge, is to be the basis of insurance if a policy is issued, but does not
obligate me to accept the insurance nor oblige the insurer to effect insurance on the risk.
Signature of applicant:
Title:
Date:
Name and address of insurance broker / agent:
CONTACT DETAILS:
Tri – Marine Acceptances (Pty) Ltd
67 Dreyersdal Road, Bergvliet 7945
P.O Box 347, Plumstead, 7801
Tel No: (021) 7131910
Fax No :(021) 7131910
Cell No: 083 309 3334 – Ian Smith
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Email Address: marinesa@iafrica.com
Company Registration No: 2012/089555/07
Juristic Representative of Infiniti Insurance Ltd. FSP 35914
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