Marine Kidnap, Extortion & Detention Insurance



Extra War Risks Insurance (EWRI) - Proposal Form

Risk Area: Red Sea / Gulf of Aden / Indian Ocean and Gulf of Oman and

adjacent waters

Please fill in the blanks in the below form with Block capitals;

Name of Ship Owners :

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Name of Ship Managers:

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Business Website Address:

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Name of person in charge

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Phone No. of person in charge

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E-mail address of company and person in charge

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Name of Charterer : (if applicable)

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VESSEL’S DETAILS

|Vessel’s name | |

|IMO-No. | |

|Built | |

|Vessel’s type | |

|GT | |

|DWT | |

|Flag | |

|Class | |

|Freeboard during Transit | |

|Laden / Ballast ? | |

|Type of Cargo (if laden) | |

|Max. speed | |

|Average speed | |

|Service speed | |

Number and Nationality of crew

|Officers: | |Crew- | |Others (please state) | |

Voyage details

|Port of Departure | |

|1st Port of Call | |

|2nd Port of Call (if applicable) | |

Return Voyage Details (if available)

|Next Port of Call | |

|2nd Port of Call (if applicable) | |

Will the vessel be registered with MSCHOA ? (mschoa.eu)

|Yes | | |No | | |

UKMTO Dubai will be notified ?

|Yes | | |No | | |

Internationally Recommended Transit Corridor and the Group Transit system used (Will the vessel be a part of organized convoy) ?

|Yes | | |No | | |

Will the “Best Management Practices” (BMP) applied ?

|Yes | | |No | | |

Estimated dates

ETA (Estimated date of arrival) at excluded areas ( Lat. 15° N / Long. 58° E / Long. 78° E / Lat. 12° S , whichever applicable)

|Applicable Lat. or Long. |Date |Hour (UTC) |

| | | |

ETD (Estimated date of departure) from excluded areas (Lat. 15° N / Long. 58° E / Long. 78° E / Lat. 12° S , whichever applicable)

|Applicable Lat. or Long. |Date |Hour (UTC) |

| | | |

K&R (Kidnap & Ransom) INSURANCE

Is Kidnap & Ransom Insurance available or required for the subject transit ?

|Yes | | |No | | |

If yes;

Limit of K&R insurance obtained / required;

a) US$ 3,000,000

b) US$ 5,000,000

(Please tick as applicable)

Is K&R Loss of Hire Cover required ?

|Yes | | |No | | |

If yes;

Daily Hire Amount required :

Number of days to be covered (60,90,120,180) :

SECURITY PRECAUTIONS

|1) Are the vessel’s fitted with Ship Security Alert Systems (SSAS), in | |

|compliance with SOLAS XI – 2 Regulation 6? | |

|2) If yes please provide name and type of equipment. | |

|3) Is this equipment capable of real time tracking of your vessel | |

|through a graphical user interface (GUI) and web interface application? | |

|4) How many position reports does your SSAS transmit on a standard basis| |

|per 24 hours? | |

|5) What is the reporting frequency (number of minutes between each | |

|position report) of your SSAS units in alert mode? | |

|6) Who responds to your ship board alerts? CSO, Flag, or other RO. | |

|7) Does your vessel(s) have a valid International Ship Security | |

|Certificate (ISSC)? | |

|8) Does your vessel routinely carry large amounts of cash onboard? If | |

|yes how much? | |

|9) Where did your CSO, SSO and ship’s crew receive their security | |

|training? | |

|10) Do your crew receive any formal training in counter – piracy | |

|measures or kidnap awareness? | |

|11) Do your shore managers receive any formal training in contingency | |

|planning for security incidents, including piratical attacks, or kidnap | |

|? | |

|12) Do you have a corporate contingency plan for security incidents, | |

|including piratical attacks, or incidents? | |

|13) Have your vessels been the victims or target of any piratical attack| |

|in the last 3 years, where the crew or vessel have been held hostage for| |

|more than 3 hours? | |

|14) In high-risk areas (such as the Malacca Strait, East and West Coast | |

|Africa, East Coast of South America and the Caribbean) what are your | |

|standard counter-piracy measures? | |

|15) Do you routinely employ security guards on board the vessel while in| |

|port, at anchor or at sea? | |

|16) If yes, how many are employed? Are they armed? Which company | |

|provides the security guards? | |

|17) Will the vessel be accopanied by a naval escort ? (no more than 3 | |

|vessels per warship for the whole length of the transit through the | |

|dangerous zone) ? | |

|18) Is the vessel registered with SSRS ? | |

|. | |

|19) Will the vessel be carrying military personnel from a recognised | |

|navy force on board during the whole length of the transit through the | |

|dangerous zone ? | |

| | |

|20) Is the vessel fitted with razor wire around guard rails on low | |

|lying deck areas ? | |

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|21) Do the master and crew have a plan to retreat to a secure citadel | |

|onboard their vessel if boarded by pirates ? | |

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Details of Anti Piracy Measures / Security Precautions taken on board (supported by pictures etc. if available)

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THE UNDERSIGNED, IN HIS CAPACITY AS AN AUTHORIZED OFFICER OF THE APPLICAN, HEREBY DECLARES TO THE BEST OF HIS / HER KNOWLEDGE THAT THE INFORMATION SET FORTH HEREIN ARE TRUE AND NO INFORMATION HAS BEEN WITHHELD.

| Signature | |Date |

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