Scribd
Upload
1K views2 pages

Product Liability Insurance Application Form

Pioneer Knitwears (BD) Ltd. is a manufacturer in Bangladesh seeking $2 million in product liability insurance. [1] The company has been in business for 2 years manufacturing ready made garments, cardigans, and sweaters primarily for export to Australia/New Zealand. [2] It requires this insurance due to agreements with its largest buyer, BIG W HK Procurement Pty Limited. [3] While the company has not had any product recalls or liability claims to date, it seeks insurance to protect against future risks.

Uploaded by

Md. Rakibul Islam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
1K views2 pages

Product Liability Insurance Application Form

Pioneer Knitwears (BD) Ltd. is a manufacturer in Bangladesh seeking $2 million in product liability insurance. [1] The company has been in business for 2 years manufacturing ready made garments, cardigans, and sweaters primarily for export to Australia/New Zealand. [2] It requires this insurance due to agreements with its largest buyer, BIG W HK Procurement Pty Limited. [3] While the company has not had any product recalls or liability claims to date, it seeks insurance to protect against future risks.

Uploaded by

Md. Rakibul Islam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Product Liability Application

APPLICANT’S INFORMATION
1. Named Insured (Include all subsidiaries):PIONEER KNITWEARS (BD) LTD.

2. Principal Address:JAMIRDIA, HABIRBARI, VALUKA, MYMENSINGH, BANGLADESH.

√
3. Business: (Please Tick)
Manufacturer Distributor Trading Company Others

How Long has the insured in this


4. 02 YEARS
business:
5. Insured’s Website address: www.pkbdl.com
√
6. Dose the insured have operations in the United States or Canada? (please tick) YES NO

If Yes,
Nature of Operation:
Rep. Office / Sales office / Others:
Number of Staff in USA / Canada:
Number of Vehicles in USA / Canada:

SALES TURN OVER IN USD to Different Countries


(Please attach Product Catalogues, Picture or Samples)

Next Year Current


Buyer Last Year 20--- 20---
7. Country Product Esti. Year
Name (USD) (USD) (USD)
(USD) (USD)
Australia/ Ready Made
BIG W HK 1,828,195 1,661,995 1,155,490
New Zealand Garments

Cardigan

Sweater

VENDOR’S LIABILITY
√
8. Does anyone require you to have this product liability insurance? (Please Tick) YES NO

If Yes, Please specify who requires this insurance and attached a copy of their agreement.
BIG W HK Procurement Pty Limited.

Page 1 of 2
LOSS EXPERIENCE

√
Is there any government-mandated recall or discontinuation of any product?
9. YES NO
(Please Tick)

If Yes, Please describe:


_________________________________________________________________________
_________________________________________________________________________
Has anyone ever requested for payment of damages for medical expenses, √
10. bodily injury or property damage caused by your products, whether insured or YES NO
uninsured?
If Yes, Please provide total incurred losses in last 5 (five) years describe:
_________________________________________________________________________
_________________________________________________________________________
Please note: if any of the answers are ”yes”, we may require more information about the
nature of the previous incidents. You may attach full details or otherwise a RIL (Reliance
Insurance Limited’s) underwriter will contact you.

INSURANCE REQUIREMENT
√
Has any insurer canceled or non-renewed your products liability insurance?
11. YES NO
(Please Tick)

If Yes, When and Why?


_________________________________________________________________________

New / Renewal Insurance Program:

$ 2,000,000
Limit of Liability Required USD: ___________________________
12.
Deductible proffered USD:_______________________________

Person to contact for inspection, if necessary:


Name:
13.
Job Title:
Contact Number:

IMPORTANT NOTE
Completion of this application creates no obligation upon the applicant to accept
insurance or upon Reliance Insurance Limited to offer insurance.

Applicants Name: Zakir Hossain Zahid

Job Title: Manager, Merchandising

Company Name: PIONEER KNITWEARS (BD) LTD.

Signature with Date:

Page 2 of 2

You might also like