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International Property & Liability for Corporate Trip Travel

General Application Information

(Required *)
Name of Business:*
E-Mail Address:*
Business Address/Street:
City/State/Zip:
Quote Needed by:
Effective date of coverage:
Web Site Address:
       
International General Liability
Coverage for:
Worldwide Lawsuits               Foreign Lawsuits Only
Desired Limits of Insurance: $
Estimated revenues generated from activities outside the U.S. & Canada: $
Address and occupancy of any owned or leased premises:
Description of Business Operations:
       
International Voluntary Workers' Compensation
Avg # of trips (less than 30 days) per year:    
Average # of employees per trip:    
Destination and purpose of trips:
       
Payroll and number of employees stationed overseas:
US Expatriates:
Third Country Nationals:
Local Counry Nationals:
Do you need Defense Base Act Insurance? No     Yes     Not Sure    
       
Automobile
Number of owned or leased vehicles overseas:
Where?
   
Number of rented vehicles per year:
Where?
   
Do you have local country auto insurance in place? No Yes    
       
Personal Property
Fax a separate page with information on additional locations to us at 301-417-0040.
  LOCATION 1 LOCATION 2 LOCATION 3
Overseas location address:
Construction:
Use of location:
Any fire or security protection in place (describe)?
Property values at location: Computers:$

All other Property:$
Computers:$
All other Property:$
Computers:$
All other Property:$
Do you travel to customer sites or to exhibitions? No Yes No Yes No Yes
What is the value of owned property (computers, exhibtion booth, etc.) you take with you? $ $ $
If you have a lease or other contract that has insurance requirements for overseas work or locations, please describe:
       
Loss History
If you've had any international losses in the last 3 years, please describe:
 
        




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