Híng dÉn båi thêng b¶o hiÓm hµng ho¸

MÉu 01 – Sæ theo dâi hå s¬ khiÕu n¹i B¶o ViÖt

MB-HD-B1-03-

20/04/2001
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Sæ theo dâi hå s¬ khiÕu n¹i §¹i lý MB-HD-B1-03-

20/04/2001
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MB-HD-B1-03-03
MB-HD-B1-03-03

Th khiÕu n¹i båi thêng tæn thÊt hµng ho¸

KÝnh göi : Tæng C«ng ty B¶o hiÓm ViÖt Nam

Chóng t«i xin göi bé hå s¬ khiÕu n¹i båi thêng cho tæn thÊt l«
hµng (nhËp, xuÊt, vËn chuyÓn néi ®Þa) ®îc mua b¶o hiÓm t¹i Quý
Tcty, chi tiÕt nh sau:

- GiÊy chøng nhËn b¶o hiÓm/ §¬n b¶o hiÓm sè :

- Tªn ngêi göi hµng :
- Tªn ngêi nhËn hµng :
- Tªn hµng ®îc b¶o hiÓm :
- Sè lîng/ träng lîng :
- Tªn ph¬ng tiÖn chuyªn chë :
- VËn t¶i ®¬n sè hoÆc Hîp ®ång chuyªn chë sè vµ ngµy :
- §i tõ : ngµy
- §Õn : ngµy
- Sè lîng hµng bÞ tæn thÊt do :
+ giao thiÕu :
+ hao hôt :
+ gi¶m gi¸ trÞ th¬ng m¹i :
+ nguyªn nh©n kh¸c :
- TrÞ gi¸ tæn thÊt :
- PhÝ gi¸m ®Þnh :
- Tæng sè tiÒn khiÕu n¹i :

§Ò nghÞ Quý Tcty xem xÐt båi thêng cho Chóng t«i vµ chuyÓn sè
tiÒn båi thêng trªn vµo tµi kho¶n cña Chóng t«i sè
t¹i Ng©n hµng

Tr©n träng kÝnh chµo

Ngµy th¸ng
n¨m

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Chøng tõ ®Ýnh kÌm :

MB-HD-B1-03-04
MB-HD-B1-03-04

B¶n thanh to¸n båi thêng

Sè : ... ... ... ... ... ... ...

KÝnh göi :

Sau khi xem xÐt hå s¬ khiÕu n¹i sè : ... ... ... ... ... ngµy ... ... ... ... ...
cña Quý C«ng ty, Chóng t«i ®ång ý båi thêng cho tæn thÊt hµng ho¸
kª khai díi ®©y:

- Tªn hµng ho¸:

- §¬n b¶o hiÓm sè :
- Tæng sè tiÒn b¶o hiÓm :
- Tªn tµu : khëi hµnh ngµy
- Tõ chuyÓn t¶i ®Õn
- VËn ®¬n sè :
- Sè lîng tæn thÊt :
- Nguyªn nh©n tæn thÊt :

Sè tiÒn båi thêng ®îc tÝnh to¸n nh sau :

Tæn thÊt hµng :

PhÝ gi¸m ®Þnh :

Tæng sè tiÒn båi thêng :

Sè tiÒn båi thêng trªn sÏ ®îc chuyÓn vµo tµi kho¶n cña Quý C«ng ty
Sè :
T¹i Ng©n hµng :

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§Ò nghÞ C«ng ty ký vµ ®ãng dÊu vµo b¶n “ Receipt and Subrogation “

®Ýnh kÌm theo ®©y, vµ göi tr¶ l¹i cho chóng t«i ®Ó lµm tµi liÖu ®ßi
båi thêng ngêi thø ba cã liªn quan tr¸ch nhiÖm ®Õn vô tæn thÊt.

Ngµy th¸ng n¨m

Tæng C«ng ty B¶o hiÓm ViÖt
Nam

BiÓu phÝ ®¹i lý Lloyd’s MB-HD-B1-03-05

Settlement of Claims Abroad

Scale of Fees for Lloyd’s Agent’s Services

The Council of Lloyd’s have recently reviewed the scale of fees for the
settlemetn of claims abroad and recoveries from third parties. The
revision is effective from 1 April 1999 and from this date Agents will
calculate their fees on the following scale using the rate of exchange
applicable on the date of adjustment when conversion is requyred in
other currencies.

General and particular average A fee of GBP 45 plus 10% on

lossed including breakage, the first GBP 700 and 4% on
leakage, pilferage, non-delivery, amounts in excess of that
salvage lossed, etc. figure, including survey fees.
Maximum fee as shown below.

General Average deposits and 3% on the amount settled.

contributions, total losses, other Minimum and maximum fees
claims or returns of premium. as shown below

Minimum fee GBP 45

Maximum fee GBP 360

“ No Survey “ Clause When this clause is included

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in the insurance document

and, in consequence, no
survey is held, the settling fee
may be surcharged by 50% of
the above rates.

For arranging general average GBP 40

guarantees

Agents are advised that shoulf the time and trouble involved in
handling a particular case warrant the charging of a fee higher than
the prescribed scale, this will be accepted provided it can clearly be
shown that the additional charge is justified by the circumstances.

They are further reminded that in addition to the fees authorized they
may recover Postal/Facsimile/Telex and Cable expenses relating to the
above services, although such expenses must clearly be shown as a
separate item.

Where claims have been refered to the Underwriters for instructions

and are subsequently declinded Agents are authorized to suMBit a fee
for Underwriters’ consideration on a time and trouble basis.

Similarly, where Agents are handling claims which they subsequently

decline or where claimants fail to pursue their claims, Agents are
authorized to suMBit a fee claculated on a time and trouble basis for
Underwriters’ consideration.

The scale of fees applicable to recoveries effected by Lloyd’s Agents

themselves from third parties is on a “ no cure - no pay “ basis and is
to be calculated as follows:

1. When no solicitors or other parties are employed:

Recoveries up to GBP 200
25% with a minimum of GBP 40
20% on the next GBP 300
10% on the next GBP 500
7 1/2 % on the next GBP 25,000
5% on the balance

2. In cases where recoveries are effected through solicitors or

other parties, Lloyd’s Agents’ fees to be assessed on a time and
trouble basis, with a minimum fee of GBP 40.

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Th th«ng b¸o båi thêng ®¹i lý MB-HD-B1-03-06

Hµ Néi, ngµy th¸ng n¨m

Sè :
V/v : th«ng b¸o båi thêng ®¹i lý

KÝnh göi : C«ng ty

Tæng C«ng ty B¶o hiÓm ViÖt Nam - ®¹i lý xÐt båi thêng cña
C«ng ty b¶o hiÓm .. .. .. .. .. .. .. .. xin th«ng b¸o víi Quý C«ng ty :
Tæng C«ng ty chóng t«i võa nhËn ®îc tiÒn cña C«ng ty b¶o hiÓm .. ..
.. .. .. .. .. .. båi thêng cho hå s¬ khiÕu n¹i cña Quý C«ng ty vÒ tæn
thÊt l« hµng .. .. .. .. .. .. .. .. , chë trªn tµu .. .. .. .. .. .. .. .. , thuéc ®¬n
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b¶o hiÓm sè .. .. .. .. .. .. .. .. , víi tæng sè tiÒn lµ .. .. .. .. .. .. .. .. ( sau

khi ®· bÞ Ng©n hµng níc ngoµi trõ ®i thu tôc phÝ )

Chóng t«i sÏ lµm thñ tôc chuyÓn sè tiÒn .. .. .. .. .. .. .. .. vµo tµi

kho¶n cña Quý C«ng ty sè t¹i Ng©n hµng .. .. .. .. .. .. .. .. . §Ò nghÞ
Quý C«ng ty ký vµ ®ãng dÊu vµo Th thÕ quyÒn ®Ýnh kÌm vµ göi l¹i
toµn bé b¶n gèc cho chóng t«i.

Xin th«ng b¸o ®Ó Quý C«ng ty biÕt vµ tiÖn theo dâi.

KÝnh chµo.

Tæng C«ng ty B¶o hiÓm ViÖt Nam

N¬i nhËn:
- Nh trªn
- Phßng TVKT
- Lu: P.NghiÖp vô,TH
( ®· ký )

Cam kÕt ®ãng gãp tæn thÊt chung MB-HD-B1-03-07

LLOYD'S AVERAGE BOND

To :
Owner(s) of the :
Voyage and date :
Port of shipment :
Port of destination/discharge :
Bill of Lading or waybill number(s) :

QUANTITY AND DESCRIPTION OF GOODS

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In consideration of the delivery to us or to our order, on payment of the

freight due, of the goods noted above we agree to pay the proper proportion
of any salvage and/or special charges which may hereafter be ascertained to
be due from the goods or the shippers or owners thereof under an
adjustment prepared in accordance with the provisions of the contract of
affreightment governing the carriage of the goods or, failing any such
provision, in accordance with the law and practice of the place where the
common maritime adventure ended and which is payable in respect of the
goods by the shippers or owners thereof.
We also agree to :
(i) furnish particulars of the value of the goods, supported by a copy of
the commercial invoice rendered to us or, if there is no such invoice,
details of the shopped value and
(ii) make a payment on account of such sum as is duly certified by the
average adjusters to be due from the goods and which is payable in
respect of the goods by the shippers or owners thereof.

Singnature of receiver of goods : Date

:
Fullname and address :
Tel No : Fax No: Telex:

B¶o l·nh ®ãng gãp tæn thÊt chung MB-HD-B1-03-08

AVERAGE GUARANTEE
Based on wording approved by the Association of Average Adjusters
And the Institute of London Underwriters
NOTE : This guarantee will be accepted provided that no additions,
deletions or amendments are made to it.
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To : The Owners of the vessel named below and other parties to the
adventure as their interests may appear
VESSEL :
CASUALTY and DATE :
In consideration of the delivery in due course of the goods specified below
to the consignees thereof without collection of a deposite, we, the
undersigned insurers, hereby undertake to pay to the shipowners or to the ...
.. ... ... ... ... ... ... ... ... ... ... ... .... , on behalf of the various parties to the
adventure as their interests may appear, any contribution to General
Average and/or Salvage and/or Special Charges which may hereunder be
ascertained to be properly due in respect of the said goods.
We further agree ;
a) to make prompt payment(s) on account of such contribution as may be
reasonable and properly due in respect of the said goods, as soon as the
same may be certified by the said Average Adjusters.
b) to furnish to the said Average Adjusters at their request all information
which is available to us relative to the value and condition of the said
goods.
PORT OF PORT OF BILL OF QUANTITY & DESCRIPTION INSURED POLICY/REF NO &
PREMIUM (IF KNOWN)
LOADING DISCHARG LADING OF GOODS VALUE
E

SIGNATURE
ADDRESS : VIETNAM INSURANCE CORPORATION 35 HAI BA TRUNG STR.
HANOI CITY, VIETNAM
TEL NO (84-4) 8262797 / 8262632 FAX NO (84-4) 8257188 / 8245473
TELEX
DATE

GiÊy biªn nhËn vµ thÕ quyÒn MB-HD-B1-03-09

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Receipt and Subrogation

Loss No.

Policy / Certificate No. :

Insured Amount :

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......
H
Company
Received from
The sum of
In full and final settlement of the claim under the above mentioned
Policy/Certificate on

Shipped per S/S

From
to

In consideration of having received this payment, we hereby agree to

assign transfer and subrogate to you, to the extent of your interest, all
our rights and remedies in and in respect of the subject matter
insured, and to grant you full power and give you any assistance you
may reasonably requyre of us in the exercise of such rights and
remedies in our or your name and at your own expense.

Dated at Hanoi, Vietnam this

day of
(Sign & Stamp)

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NB. This document must bear the Legal stamp necessary for Agreement

Th dù kh¸ng/ th«ng b¸o tæn thÊt MB-HD-B1-03-10

Notice of Loss and Damage (to carrier)

( ), 2000

Messrs. ( )
(Agents for )

Dear Sirs,

s.s ... ... ... ... ... ... ... ... ... ...

Please be advised that ( ) damage has been found in connection with

the shipment of the below-mentioned cargoes,

B/L No. Marks No. of Package Description

Shipped by ( ) from ( ) on board the s.s ( )

consigned to us under Bill of Lading No. ( ), and arrived at ( ) on ( ),
1999

We hereby declare that we reserve the right to file a claim with you for this
damage when the details and amount of the damage are ascertained. Please
acknowledge this notice in writing

Very truly yours

(sign and stamp)

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