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:	Make a selection Frame Masonry Non-Combustible Fire Resistive Metal	Make a selection Frame Masonry Non-Combustible Fire Resistive Metal	Make a selection Frame Masonry Non-Combustible Fire Resistive Metal
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: