Confidential

Ship Managers proposal form

Please mail or fax to International Transport Intermediaries Club Limited 90 Fenchurch Street, London, EC3M 4ST
Tel +44 (0)20 7338 0150 Fax +44 (0)20 7338 0151
Email itic@thomasmiller.com Web www.itic-insure.com

Company Name
Address

Email VAT No
Telephone Fax
Name of person at your company to whom
correspondence should be addressed
Insurance broker to whom quotation should be sent

The insurance cover offered by ITIC to ship managers is based on the premise that the ship manager carries out his
functions under the ship management contract as agent for his ship owner principal. Furthermore, the cover provided
by ITIC is on terms no more onerous than the BIMCO Shipman 98 or the latest revision which is BIMCO Shipman
2009 which is now the standard ship management contract world-wide.

The term ship management covers a wide range of activities ranging from consultancy to the performing of all the
functions of a ship owner. However, unless specifically declared and agreed by the Club, only those activities
performed under a specific ship management contract will be insured. We have listed below the majority of activities
undertaken by ship managers and would ask you to indicate which activities are undertaken by you.

Please provide us with a copy of your standard ship management contract. (See
Question 5)

1 General Information (If additional space is required please list separately)

On the following page, please list the ships under your management, with details of their age, flag, type and
tonnage as well as the names of their owners and beneficial owners.

Please also specify the nationality of the crew and who has supplied them.

Please also indicate if any of these ships are managed on behalf of banks, leasing companies, finance
houses, investors (equity schemes of K/S partnerships). If any of the listed ships are managed in this way,
please give details on a separate sheet.

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Do you have any financial interest in the ships under your management? YES NO
Do the owners of any of the ships you manage have any financial interest in your
company? YES NO
delete as appropriate
2 Ship Management Activities
Please indicate which of the following activities you undertake for the ships you manage
a. Technical
i. Vessel superintendence YES NO
ii. Property maintenance YES NO
iii. Appointing surveyors YES NO
iv. Obtaining class & flag approvals YES NO
v. Arranging spares, stores & victualling YES NO
vi. Arranging repairs/dry dock YES NO

b. Crewing
i. Arranging for the employment of crew as agent for the owner YES NO
ii. Arranging crew travel YES NO
iii. Arranging crew national insurance requirements YES NO
iv. Ensuring ITF acceptability of crew YES NO
v. Negotiating with unions YES NO
vi. Supplying crews employed in your own name YES NO
(If Yes, please complete the separate additional form for crew managers),
(In either case you will not be insured for claims by crew members or their dependants and relatives under crew
employment contracts)

c. Operations
i. Issuing instructions to masters YES NO
ii. Appointing and funding of agents YES NO
iii. Issuing bill of lading (If Yes please attach examples) YES NO
iv. Liaising with charterers YES NO
v. Arranging bunker stems YES NO
(Do you re-invoice the owners for goods and services supplied, e.g. bunkers? Re-invoicing usually results in your
becoming the principal and therefore directly responsible for e.g. the quality of bunkers supplied. You will not be
insured if you contract as a principal).

d. Commercial management
i. Arranging charter parties or contracts of affreightment YES NO
ii. Canvassing for cargoes YES NO

e. Accounting
i. Ship husbandry accounting YES NO
ii. Voyage accounting YES NO
iii. Collection of bill of lading freights YES NO
iv. Collection of voyage freight/charter party hire YES NO
v. Arranging payment of bareboat or time charter hire YES NO

f. Insurance
i. Do you place the ships insurances? YES NO
ii. Hull YES NO
iii. P&I YES NO
iv. War YES NO
v. Strikes YES NO
vi. Loss of hire YES NO
vii. Other (please specify)
viii. Do you sub-contract the placing of the ships insurances? YES NO
ix. Are you co-insured on the owners insurance policies? YES NO
(It will be a condition of your insurance with ITIC that you are named as co-assured on the owners P&I and hull
insurance policies)
x. If not co-insured, do underwriters waive their rights of recourse against you? YES NO
xi. Do you handle insurance claims against e.g. stevedores? YES NO
xii. Are the ships which you manage insured by P&I Clubs in the International Group?
YES NO
xiii. If not where is their P&I insurance placed:

xiv. Are the ships under your management all classed by a classification society
that is a Member of the IACS? YES NO
delete as appropriate
3 Gross Annual Income
For the purposes of underwriting all we require is a declaration of the gross annual income that you earn as a ship
manager. Please indicate currency e.g., US$
a. Last financial year b. Estimate for this financial year
c. Estimate for next financial year

4 Sub-contracting
Do you sub-contract any of the activities which you undertake to companies that
will not be shown as co-assured under your terms of entry? YES NO
If Yes, do you maintain your rights of recourse for their errors and omissions? YES NO
Do you require these companies to have insurance for their errors and omissions? YES NO
Do you undertake any other activities for the ships which you manage? YES NO
If Yes, please specify

Are you a member of the InterManager YES NO

Have you received quality assurance certification (if yes please provide details) YES NO
delete as appropriate

5 Ship Management Contract

a. Do you contract on either BIMCO Shipman 98 or 2009? YES NO
b. Do you agree to US law or arbitration as the governing law of the contract YES NO
in any ship management agreement?
If Yes, please advise the number of vessels where you agree to US law or arbitration:
c. If the answer to question 5 b. was No, please advise what governing law and jurisdiction has been
agreed under the ship management contract (please tick as appropriate):
English
German
Norwegian
French
Other (please specify)
THE FOLLOWING ACTIVITIES WILL NOT BE REGARDED AS BEING THE NORMAL
BUSINESS OF A SHIP MANAGER:

Consultancy, commercial evaluation and planning services

New building supervision and administration

SOME ACTIVITIES WILL ONLY BE INSURED IF SPECIFICALLY AGREED

6 Claims History

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a. Have any claims been made against you, or have there been any circumstances
likely to give rise to a claim being made against you, in the last 5 years? YES NO
delete as appropriate
If Yes please give details on a separate sheet

b. Has any insurer

i. Declined to insure you YES NO ii. Cancelled your insurance YES NO
iii. Refused to renew your iv. Imposed penalties or
insurance YES NO special terms YES NO
delete as appropriate
If Yes please give details on a separate sheet

c. Are you currently insured against the risks covered by ITIC? YES NO
If Yes, with whom?
delete as appropriate

7 Please supply any literature about your company relevant to this proposal.

DECLARATION
We declare that the information and answers given in this form are true to the best of our knowledge and
belief and that we have not mis-stated or suppressed any material facts that might influence the Clubs
assessment of the risk. We also understand that completion of this form does not bind either the Club or
ourselves to accept this insurance but, if terms are agreed, it will form part of our contract with the Club.

Signed
Status of Signatory
Date
This proposal form must be completed and signed by a person who is authorised to bind the proposer.

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