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Carriers/Couriers Insurance Form
This is not a vehicle insurance policy, you will need to purchase insurance to cover the vehicle separately.
Acceptance Criteria
Please read the statement below and choose an answer.
1. No insurer ever declined to insure you or refused to renew or terminated your Carriers Liability/Transit Insurance?
Or
2. Neither you or your directors or partners have ever been convicted of or charged with (but not yet tried for) a criminal offence other than a motoring offence?
Or
3. That you have not had any Carriers Liability/Transit losses or claims in the last 2 years?
I Agree:
*
Yes
No
Personal Details
Title:
*
Please select
Mr
Mrs
Miss
Ms
Name
*
First
Last
Postal Address:
*
Second Line Of Address:
Town/City:
*
County:
*
Eircode
Phone Number:
*
Email Address:
*
Business Details
Occupation:
*
Please select
Carrier
Courier
Vehicle Details:
Please note that is is not a motor insurance policy.
Make:
*
Model:
*
Registration:
*
Cover Details:
Sum Insured:
*
Please select
€10,000
€20,000
€30,000
Optional Extensions to cover:
Transhipment and other costs
Sheets, ropes and other equipment
General Average and Salvage Charges
