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Annual Marine and Transit Insurance - Renewal Declaration Form

Please complete the following information and submit this form to assist us in arranging and providing your insurance renewal.

All information you provide must be correct, true, and accurate as incorrect or misleading information may alter our quote and jeopardise cover if you proceed with a policy.

Please refer to the CGIB Financial Services Guide, Privacy Statement, General Advice Warning and Duty of Disclosure before completing this form.

You have errors in your submission, they are highlighted in red below

INSURED'S Details

Insured Name*
Property Address*	Post Code*	City/Town
Postal Address*	Post Code*	City/Town

Details

Worldwide Marine

Is cover required for your goods that you export and/or import?*

Total estimated annual imports to Australia for the next 12 months *	$
Largest any one import shipment to Australia for the next 12 months*	$
Actual total imports to Australia for the last 12 months*	$
Total estimated annual exports for the next 12 months*	$
Largest any one export shipment for the next 12 months*	$
Actual total exports for the last 12 months*	$
List all the countries you import from*
List all the countries you export to:*
List all the types of goods you import and/or export*

Transit within Australia

Is cover required for your goods in transit? *

Total estimated annual sending's within Australia for the next 12 months	$
Largest anyone sending within Australia for the next 12 months*	$
Actual sending's within Australia for the last 12 months*	$
List all the types of goods you send:*

PREVIOUS INSURANCE

Have you ever suffered any losses or claims*	Yes No
Have you ever had any insurance cancelled or declined or special terms imposed?*	Yes No
Have you ever been charged or convicted of any criminal offence or declared bankrupt?*	Yes No
Are you aware of any matters not disclosed above that is relevant to the underwriters consideration of this insurance?*	Yes No

Please provide all relevant information to all questions answered "Yes".
Please include where applicable*

CONTACT Details

First Name*
Surname*
Phone Number*
Email Address*

Important Information

By proceeding you agree to the Terms of Use of this site and that you have read and understood this Important Information about answering questions that we ask of you.
We will handle your personal information in accordance with our Privacy Policy.

Completion of this form does not put an insurance policy/cover in place - you will need to contact us to arrange insurance cover.

Tick to agree*

Other Insurance Needs

Do you require any further information on other insurances?

Office Insurance

Management Liability

Landlords Commercial

Landlords Residential

Public Liability

Cyber

Motor Vehicle

Home & Contents

Machinery

Travel

* Mandatory Fields

Thank you for completing our online form.
We will endevour to contact you with your insurance details soon.

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Terms of Use

Your access and use of this website constitutes your agreement to these Terms of Use.
"This website" means all web pages located on the cgib.com.au domain name.
This website is the website of Commercial & General Insurance Brokers (Aust) Pty Ltd, ABN 12 087 001 045.
The CGIB trademarks are registered by CGIB. The CGIB trademarks may not be used or reproduced without the prior written consent of CGIB.
The information contained on this website may not be accurate or up to date in all respects. We do not warrant the accuracy or completeness of any information contained on this website.
The CGIB Quotation Services are offered solely to assist you to purchase or decide to purchase insurance from us. You are not authorised to use high-volume, automated or systematic processes to obtain premium estimates or make insurance applications. You agree not to compile, repackage or disseminate for commercial purposes any information provided by use of these Quotation Services without our prior written consent. We reserve the right to terminate your access to these services in our sole discretion, including for submitting excessive requests for these services.
CGIB expressly disclaims that it operates any website other than this website. This website may contain links to third party websites. CGIB and its related entities do not make any representations as to the contents of any third party websites, are not responsible for and will not be liable for the content of any third party websites.
The information on this website is provided for Australian residents only, and where indicated, may be limited to specific states and territories of Australia. The law applicable in the State of New South Wales will apply to this website unless other states or territories are expressly provided.

Important Information

When answering our questions you must be honest as the answers will form the basis of our decision to insure you. Your answers apply to you and to anyone else that may be insured under the policy. If you have not answered our questions in this way, we may reduce or refuse to pay a claim, or cancel the policy.

Our Privacy Policy

We are committed to protecting your privacy and confidentiality in accordance with the Privacy Act 1988 (Cth) including the Privacy Amendment (Enhancing privacy Protection) Act 2012 and it is one of our prime concerns that any personal or sensitive information you provide to us is not used for any other purpose than that intended and expected by you. This Privacy Policy describes our current policies and practices in relation to the handling and use of personal information.

What information do we collect, hold and how do we use it?

We will collect personal information for primary purposes, which are relevant to providing and administrating our financial products and services.
To enable us to provide advice on and arrange financial services, we collect the information needed by ourselves to ensure appropriate advice to you and information required by product suppliers. We will usually provide some or all of this information to our product suppliers. Some of these companies may be located outside Australia.
When a claim is made under an insurance policy, to enable us to assist in the claim process, we and our representatives and those of the insurer (including loss adjusters, investigators, medical advisers and lawyers) collect information about the claim, some of which may be personal information. We may collect the information from you or from third parties.
We provide this information to the insurer and or their agents and those appointed to assist you in making a claim. Again this information may be passed on to your underwriters and reinsurers. We may use your personal information internally to help us improve our services and help resolve any problems.

What if you don’t provide some information to us?

We can only apply for and arrange financial service products if we have all relevant information. The insurance laws also require insured’s to provide all the information required by the end insurer to help them decide whether to insure you and on what terms. Credit Providers also require specific information to help them assess any credit applications that we may facilitate on your behalf.

How do we hold and protect your information?

We hold the information we collect from you in our computer system and in our hard copy files. We ensure that your information is safe by following the usual security procedures expected by our clients.

Will we disclose the information we collect to anyone?

We may disclose information to:

Financial institutions, other Australian Financial Service Licensees, Insurers, underwriters, underwriting agencies, wholesale brokers and reinsurers (for the purpose of seeking recovery from them or to assist them to assess insurance risks);
Premium funders / Credit providers for the purposes of gaining quotations on and arranging funding of your insurance premiums / financial investments.
An investigator, assessor, State or Federal Health Authorities, lawyers, accountants, medical practitioners, hospitals or other professional advisors (for the purposes of investigating or assessing your claim);
A lawyer or recovery agent (for the purpose of defending an action by a third party against you or for the purpose of recovery costs including your excess);
Contractors who supply services to us, e.g. to handle mailings on our behalf.
An immediate family member;
Other companies in the event of a corporate sale, merger, reorganisation, dissolution or similar event

However, we will do our best to ensure that they protect the information in the same way that we do. We may provide this information to others if we are required to do so by law or under some unusual other circumstances which the Privacy Act permits. We do not sell, trade, or rent personal information to others.

How can you Access, check, update or change your information?

Upon receipt of your written request from you and enough information to allow us to identify the information, we will disclose to you the personal information we hold about you. We will also correct, amend or delete any personal information that we agree is inaccurate. If you wish to access or correct your personal information please write to the Privacy Officer, C/- our office.
We do not charge for receiving a request for access to personal information or for complying with a correction request. We do however reserve the right to charge you for all reasonable costs and outgoings specifically incurred in meeting your request for information.

Your consent

By asking us to provide you with our financial services, you consent to the collection and use of the information you have provided to us for the purposes described above.

Complaints About Privacy

Should you have a complaint regarding a breach of privacy please contact our Complaints Officer who will handle the matter in accordance with our formal complaints handling procedures.
Your complaint can be lodged over the phone, via mail or email or you may wish to make an appointment with our Complaints Officer at a convenient time and location. We will do all that is reasonable in the circumstances to address your complaint.

Information Sent Overseas

In certain situations it is likely that that some or all of the Personal Information that you provide to us may be disclosed to businesses that operate overseas. This would only occur where the product provider / intermediary is based overseas – e.g. Lloyds of London syndicates or brokers and other overseas based insurers and intermediaries or in situations where we utilise “Cloud Computing” services that are situated outside Australia.

In all such cases we commit to making reasonable enquiries to ensure that these organisations comply with their local privacy legislation where such legislation is comparable to the Australian legislation and to comply with the key components of Australian Privacy legislation in cases where their local legislation is considered inadequate or non-existent

How to contact us

If you wish to gain access to your personal information, or you want us to correct or update it, or you have a complaint about a breach of your privacy, or any other query relating to our Privacy Policy, contact our Privacy Officer during business hours on:

Telephone: 1300 764 244
Mail: cgib, Suite 4, Level One, 1016 Doncaster Road Doncaster East VIC 3109