Motor Truck Cargo Insurance

We accept requests for quotes only from licensed agents or brokers. However if you are interested in an Insurance Quote please contact us (E-MAIL, PHONE, FAX) and we will refer you to a licensed broker near you.
- Agency Name
- Address
- Contact Name
- Agency Account Nbr.

If you do not have an account with FTP complete and forward our
New Brokerage Account Questionaire

Select State in which the Risk is located:


Owner's Form Carrier's Form
All Risk Carrier's Liability
Specified Perils Specified Perils


- Applicant's Name
- Address

Previous Policy Number
Desired Effective Date

QUESTIONS APPLICABLE TO BOTH OWNERS AND CARRIERS COVERAGES

Limits of Liability Desired:
If Vehicles are not to be Scheduled (All vehicles are afforded same limit)
$ on any cargo carrying vehicle or any combination thereof operating in tandem.

No. of Trailers No. of Tractors No. of Trucks Avg. Age of Veh.
Special Equipment:
Refridgerator Units Tank Trucks

If Vehicles are to be scheduled (Required if all vehicles are not afforded same limit)

Model Year Manufacturer Body Type Load Capacity Serial Number Limit of Liability


Catastrophe Limit: $ any one loss disaster or casualty, whether loaded or unloaded.

DEDUCTIBLE AMOUNT
RADIUS OF OPERATIONS Within 50 miles %
50 to 200 miles %
Over 200 miles %
PRINCIPAL CITIES SERVED
AVERAGE LENGTH OF SERVICE OF DRIVERS %
ARE ALL DRIVERS FULL TIME EMPLOYEES? - YES - NO

HOW ARE PROSPECTIVE DRIVER EMPLOYEES SCREENED?

PRINCIPAL COMMODITIES CARRIED

PERCENTAGE OF SHIPMENTS REQUIRING RIGGING %

If any of the following commodities are hauled give the percentage that each represents to the total of all comodities hauled.
Alcoholic Beverages % Flammable Fluids % Cigarettes and Cigars %
Eggs % Explosives % Automotive Parts and Tires %
Bulk Liquids % Meat or Fish % Radios, TV's and Electronic Equipment %
Drugs % Clothing % Precious Metals and Alloys %


Describe losses for the past three years
DATE AMOUNT PAID DEDUCTIBLE CAUSE OF LOSS


Terminal Limits Desired - at the following locations, whether loaded or unloaded: Occupancy and Construction
$ at
$ at
$ at


Burglary protection at terminal: - Watchman Service - Burglar Alarm
Describe:


File protection at terminal: -Automotive Sprinkler System - Smoke Detectors
- Other Describe:


Gross Receipts from hauling for past three years
AMOUNT YEAR
$
$
$
ESTIMATED GROSS FOR NEXT 12 MONTHS
$

List filings needed with ICC or states and applicable docket numbers:

PERCENTAGE OF SHIPMENTS WHICH ARE FULL TRUCKLOAD OR SEALED LOAD %

Is coverage desired for hauling owned goods? - YES - NO
Describe Commodities:


CURRENT AMOUNT OF OS&D CLAIMS HOW MANY CLAIMS ARE INVOLVED
ANY INTERLINE AGREEMENTS? - YES - NO
Describe Commodities:



QUESTIONS APPLICABLE TO OWNERS COVERAGES

Total values shipped on vehicles owned, leased or operated by applicant during past three years:
AMOUNT YEAR
$
$
$
ESTIMATED VALUES FOR NEXT 12 MONTHS
$

Premium Payment Basis Desired: - Flat Premium
Reporting Form: - Monthly - Quarterly - Annually

IS COVERAGE FOR LOADING AND UNLOADING DESIRED? - YES - NO


QUESTIONS TO BE ANSWERED BY BROKER

HOW LONG HAVE YOU KNOWN APPLICANT?

DO YOU RECOMMEND THIS RISK FROM A FINANCIAL AND PHYSICAL STANDPOINT?
- YES - NO

LIST OF CURRENT POLICIES AND TYPE WHICH YOUR AGENCY IS WRITING FOR APPLICANT



Enter any Additional Information Here:


Thank You for submitting this risk.
We will be back to you with a Quote as quick as we can.

Maintained by T-COM Associates, LTD.