"*" indicates required fields Step 1 of 4 25% Your DetailsName* First Last Address* Street Address Suburb State Postal Code Contact Number*Email* Period of InsuranceStart Date* DD slash MM slash YYYY Expiry Date* DD slash MM slash YYYY Insured Name* First Last ABN Trading Name Business Occupation Insured GoodsPlease specify the type of goods to be insured*SelectNewSecondhandFreshChilledFrozen( a Livestock Imports/Exports questionnaire must be completed for transit of livestock )Please provide details Please indicate the condition of the goods:*SelectPackedUnpackedPlease provide details Will the goods be shipped in fully enclosed shipping containers?*SelectYesNoPlease provide details of shipping Please select if goods to be insured : are over-height or over-width to fit into enclosed containers require special lifting apparatus for loading and unloading require storage within a specific temperature range require refrigerant if voyage exceeds 12 hours are fragile are susceptible to rust, oxidisation or discolouration are subject to an on deck bill of lading Please provide details of special instructions for packers, shipping and forwarding agents and carriers for the safe carriage of the selected goods Voyage and ConveyancesType of conveyance:*SelectSeaAirDate transit commences* DD slash MM slash YYYY Please provide details of conveyance (including vessel name, airline and flight number as applicable)Transit from* Transit to* Port of discharge if not final destination Will the goods be transhipped?*SelectYesNoPlease provide details CoverDo you require 'all risks' cover as per Institute clauses for the goods?*SelectYesNoPlease provide details of level of cover required Do you require an excess (in addition to any compulsory excess which may apply)?*SelectYesNoPlease provide details ($) Sum InsuredSum Insured ($)* Does the sum insured represent CIF + 10%*SelectYesNoPlease provide details Consent* I agreeNon Disclosure: If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning. In addition to the above, following documents can be viewed on our website: PRIVACY POLICY: https://www.imcinsurance.com.au/privacy/ FINANCIAL SERVICES GUIDE (FSG): https://www.imcinsurance.com.au/financial-services-guide/ CONTACT US: IMC Insurance Brokers Pty Ltd | ABN 79 676 680 946 | AFSL 229344 Level 1 251-253 Malvern Road, South Yarra, VIC 3141 | 1300 251 253 | insure@imcinsurance.com.au Δ