MA-528 Application for War Risk Insurance

0
u.s. Depatmenl at Trcnporlatlon

MmIIkne Aa._"allorl

Pursuant to Title XII of the Merchant Marine Act, 1936,as amended,and in accordancewith all applicableprovisions
of law and subject to all limitationsthereof,applicationis herebymade for WAR RISK INSURANCE as follows
(check aI/ that apply):

1.0

2.0

War Risk
Hull
Insurance

War Risk

3. 0 War Risk
P&I
Insurance

Disbursements
Endorsement

4.0

Second
Seamen's
War Risk
Insurance (1955)

5. Name of Assured(s)

6. Address of Assured(s) (Number; Street, City, State, Zip Code)

Identify with a letter followingthe name whetherassuredis owner (A), charterer(B), mortgagee(C) or other (D).

Has ma;rtgageebeen notifiedof this application?Yes

No

Not required

7. Loss, if any, payable to

8. Name of Mortgagee (if applicable)

(See Appendix A for hull and P&/)

(SeeAppendix8)

or order.
9. Vessel Name(s)

10. OfficialNo.

(SeeAppendixB for items9-13)
Form MA-528
(Rev. 4-96)

11.Flag

12. Gross tonnage

13. Date
Built

HULL-Sum insured (See Appendix B), but in the event of damage to or actual or constructive total loss of
the vessel, the insured value will be not in excess of $
*, which latter amount is the stated valuation
of that vessel as determined by the Secretary of Transportation in accordance with section 1209(a), litle
XII of the Merchant Marine Act, 1936, as amended. This insurance does not cover loss of disbursements
provided hereinbelow, as additional coverage, as a consequence of the actual or constructive total loss of
said vessel. It is understood that, with respect to damage to or actual or constructive total loss of the
vessel, this insurance shall not exceed the "sum insured" or the "stated valuation," whichever is the lesser
amount.

DISBUASEMENTs-{consumable and subsistence stores, slop chests, bar stock and bunker fuel)Insured for

(See Aooendix B)
dollars against the risks of loss as a consequence of the actual or constructive total loss of
the vessel insured hereunder. This insurance is optional and is provided applicants for hull insurance as
additional coverage. In the event of loss, payment of claim shall be limited to the actual value of the disbursements loss but not exceeding the amount so insured.
WAR RISK PROTECTION AND INDEMNITY INSURANCE-5um to be insured as speci~ed for each
vessel listed in Appendix 8, but not exceeding $750 per gross ton of the vessel.
SECOND SEAMEN'S WAR RISK INSURANCE (1955)-Loss, if any, payable in accordance with and in
the amount specified in the applicable provisions of the Second Seamen's War Risk Policy (1955), or as
modified by shipping articles, collective bargaining agreements or other applicable employment
agreements which are in effect as of the date of a casualty involving the subject vessel. Upon the
attachment of this binder, the number of crew members and modified benefits payable as of that date shall
be declared immediately to the Underwriting Agent. Any subsequent changes will be likewise declared.

To attachautomatically upon and simultaneously with (a) the outbreak of war (whether there be a
declaration of war or not) between any of the following countries: United States of America, United
Kingdom, France, the Union of Soviet Socialist Republics, or the People's Republic of China; or (b) upon
and simultaneously with the occurrence of any hostile detonation of any nuclear weapon of war including
any weapon of war employing atomic or nuclear fission and/or fusion or other like reaction of radioactive
force or matter wheresoever or whensoever such detonation may occur and whether or not the vessel may
be involved.
To terminate thirty (30) days after the outbreak of war (whether there be a declaration of war or not)
between any of the aforesaid countries.
Terms and Conditions: Subject to form of policy prescribed by the Maritime Administrator, acting for the
Secretary of Transportation. The category (one only) of eligibility under which application is made must be
designated.
0 (a)
A vessel registered, enrolled or licensed under the laws of the United States; any tug or barge or other
watercraft (documented under the laws of the United States, or undocumented) owned by a citizen of the
United States, used in essential water transportation within the territorial waters of the United States; and
U.S. citizen-owned watercraft in the fishing trade or industry, except when used exclusively in or for sport
fishing.
0 (b)(1)
A foreign-flag vessel under Panamanian, Honduran, Bahamian, or Liberian registry, 1,500 gross tons and
over, self-propelled, and not over twenty years of age (unless authorized by the Maritime Administration),
which is subject to an unqualified Contract of Commitment with the United States in form as required by

.If this valuation is not inserted when the binder is issued, it will be published in the Federal R~ister
amended from time to time.

pursuant to 46 CFR 309. as

the Maritime Administration, and which is owned by a U.S. corporation, or a foreign corporation in which a
majority of the stock is owned and controlled by U.S. citizens, whether direct or through intervening
corporations, foreign or domestic. Where such intervening corporations are foreign, the ultimate majority
ownership and control of the stock of such corporations must be vested in a citizen or citizens of the
United States as defined in section 1201(d), Merchant Marine Act, 1936, as amended.

0 (b)(2)
A foreign-flag vessel under Panamanian, Honduran, Bahamian, or Liberian registry, 1,500 gross tons and
over, self-propelled, and not over twenty years of age (unless authorized by the Maritime Administration),
which is subject to an unqualified Contract of Commitment with the United States in form as required by
the Maritime Administration, and which is owned by a foreign corporation which is not directly or
beneficially owned by U.S.citizens or corporations, but which vessel is under a long-term charter or other
long-term contract covering the use of the vessel on terms deemed by the Maritime Administration to
subject the vessel to U.S. control in the event of emergency. The charterer of such a vessel must be either
a U.S. corporation or a foreign corporation in which a majority of the stock is owned and controlled by U.S.
citizens, whether direct or through intervening corporations, foreign or domestic. Where such intervening
corporations are foreign, the ultimate majority ownership and control of the stock of such corporations must
be vested in a citizen or citizens of the United States as defined in section 1201(d), Merchant Marine Act,
1936, as amended.
0 (c)
All other vessels will be insured at the sole discretion of the Maritime Administrator, but only when engaged
in a service which has been determined by the Maritime Administrator to be in the interest of the. national
defense or the national economy of the United States.
It is warranted, as to a vessel in any of the above categories, that at all times during the binder period or
any period of insurance attaching thereunder, the vessel will comply with Department of
CommercefTransportation Orders T-1 and T-2 (44 CFR Parts 401,402, and 403) or any modification
thereof so long as they remain in force.

Warranted,as to a vessel in any eligible category, that at all times during the binder period or any period of
insurance attaching thereunder, the vessel, by action of its owner or master, will comply with the
requirements of the vessel position reporting system as prescribed in 46 CFR 308.2(c). The applicant
warrants as to a vessel in any eligible category of the application that, without prior approval of the
Maritime Administration, the vessel will not, at any time during the binder period or any period of insurance
attaching hereunder, be chartered for a period of longer than six (6) months, or for a voyage or voyages
the duration of which will probably exceed six (6) months, to any person not a citizen of the United States,
nor be chartered to such a non-citizen under a demise or bareboat form of charter, nor be chartered to
such a non-citizen for the carriage of cargoes of any kind to or from any of the countries listed in 46 CFR
221.7 or any modification thereof so long as it remains in force, or for use in the fisheries.
The applicant further warrants with [espect to a vessel in category (a) that at and from the date of issuance
of the interim binder and for and during the term of any insurance attaching thereunder, such vessel will
remain eligible within its category.
The applicant further warrants with respect to a vessel in category (b)(1) or (b)(2) that the vessel will
maintain its eligibility within its applicable category at all times from and after the issuance of the interim
binder, and will be made available to the U.S.Government upon request in the event of national
emergency pursuant to the terms of the Contract of Commitment submitted herewith; and agrees, in
this connection, that during the period of the binder and any insurance attaching thereunder, any charter
or other contract covering the use of the vessel during such period shall be subject to termination or
suspension without notice in the event the United States requires the use of the vessel under the voluntary
Contract of Commitment submittedherewith.

The applicant further warrants with respect to a vessel in category (c), that at all times such vessel will
remain in the approved service which the Maritime Administrator has found to be in the interest of the
national economy or the national defense of the United States.
In addition to the aforesaid warranties, the applicant submits certain statements, certificates and/or
agreements which are made part of the insurance application, for vessels in the following categories:

Category (b)(1) Applications: (a) An executedContractof Commitment,in form as prescribedin Section
308.5, under which applicantcommitsitself to make the vessel availableto the U.S. Govemmentupon
request in the event of nationalemergencyon the same terms and conditionsas vessels owned by
citizens of the United States are availablefor requisition,for title, or for use, in accordancewith the
provisionsof section 902(a), MerchantMarineAct, 1936,as amended.In the event this insurance
applicationis determinedto be ineligibleunderthe terms of the MaritimeAdministration'sregulations,it is
understoodthat the applicantwill be so advisedand the executedContractof Commitment(which is
submittedin considerationof the issuanceof such insurance)shall be returnedto applicantby the
MaritimeAdministration.(b) A Certificateof Ownershipand Control by U.S. Citizens,AppendixC to this
application,executedby the vessel owner establishingthat the vessel is owned by a U.S. ~orporation,or
that a majority of the stock of the owningcorporationis ownedand controlledby U.S. citizens,as defined
in section 1201(d), MerchantMarineAct, 1936,as amended,whether direct or through intervening
corporations,foreign or domestic.(c) Wheresuch interveningcorporationsare foreign, an additional
Certificateof Ownership,in the form of AppendixC, shall be executedand appendedhereto, by each such
corporationestablishingthat the ultimatemajorityownershipand control of the stock of such corporationis
vested in a citizen or citizens of the UnitedStatesas definedin section 1201(d), MerchantMarin~Act,
1936, as amended.(d) If prior official actionor approvalof the Contractof Commitmentwith the United
States is requiredby the governmentof the countryof vessel'sregistry as a prerequisiteto the execution
of such a contract,applicantattachesa certifiedcopy of such official action or approval.If a vessel in
category (b)(1) attains twenty years of age on or prior to the effectivedate of this insurance,applicant
agreesthat the subject insuranceshall not attach without MaritimeAdministrationapproval.
Category (b)(2) Applications: (a) A Contractof Commitment executed by both the owner and charterer in
form as prescribed in Section 308.5, under which they commit themselves to make the vessel available to
the U.S. Govemment upon request in the event of national emergency on the same terms and conditions
as vessels owned by citizens of the United States are available for requisition, for title, or for use, in
accordance with the provisions of section 902(a), Merchant Marine Act, 1936, as amended. In the event
this insurance application is determined to be ineligible under the terms of the Maritime Administration's
regulations, it is understood that the applicants will be so advised and the executed Contract of
Commitment (which is submitted in consideration of the issuance of such insurance) shall be retumed by
the Maritime Administration. (b) A copy of the long-term charter or other long-term contract covering the
use of the vessel and all addenda, certified to be full and complete copies (except as to rate of hire or
freight). The charterer also agrees to furnish the Maritime Administration a certified copy of any
subsequent amendments to such charter. (c) A Certificate of Ownership and Control by U.S. Citizens,
Appendix C to this application, executed by the charterer establishing that it is a U.S. corporation, or a
foreign corporation in which a majority of the stock is owned and controlled by U.S. citizens, whether direct
or through intervening corporations, which may be either foreign or domestic. (d) Where such intervening
corporations are foreign, an additional Certificate of Ownership, in the form of Appendix C, shall be
executed and appended hereto, by each such corporation establishing that the ultimate majority ownership
and control of the stock of such corporation is vested in a citizen or citizens of the United States as defined
in section 1201(d), Merchant Marine Act"1936, as amended. (e) If prior official action or approval of the
Contract of Commitment with the Unfted States is required by the government of the country of vessel's
registry as a prerequisite to the execution of such a contract, applicants attach a certified copy of such
official action or approval. If a vessel in category (b)(2) attains twenty years of age on or prior to the
effective date of this insurance, applicants agree that the subject insurance shall not attach without
Maritime Administration approval.

Category (c) Applications: A copy of the statement of vessel's service previously submitted by the
applicant, which was the subject of a finding by the Maritime Administrator that such service is deemed to
be in the interest of the national defense or the national economy of the United States.
Warranted free from any claim for loss, damage or expense covered under any commercial policy in effect
for the benefit of the assured.

Warrantedfree from any claim for loss, damage or expense which is or could be covered by a commercial
war risk policy containing the American Institute Hull War Risk and Strikes Clauses (including Automatic
Termination and Cancellation Provisions) for attachment to American Institute Hull Clauses, December 1,
1977.
Applicant also attaches appropriate vessel data as required in 46 CFR 309.8.
The warranties and representations in this application, which are made in consideration of the issuance of
the insurance (above) indicated, shall become a part of this application and be deemed incorporated in the
binder and in any insurance policy issued thereunder, to the same extent as though set out in full in such
documents.

Binding Fee (Not Returnable)

Insurance
HullP&I
2nd Seamen's

Foreign-FlagVessels..

U.S.-Aa~~~

Type of
Under
500 GAT

500 GAT
and Over

LASH or
Similar Barge

$25

$100

$5

$25

Under
500 GAT

$200

$50

$5

$75

500 GAT
and Over

$50

N/A

LASH or
Similar BargE:

$10
$10

$150

N/A

N/A = Not Applicable
. There Is no separate fee for disbursements endorsement.

.. Payablein U.S. funds.
Check payable to the order of "Maritime Adm.-Transportation,8 enclosed herewith.
Rate of premium to be fixed by the Maritime Administrator, acting for the Secretary of Transportation

Dated

19.

Applicant(s)

By
AuIotz8d S918bJr8

By:
~edSlgnalurw

Binder to be sent to

Name
Address

(Applicationson category(a) vessels to be submitted,with requiredattachments,to the AmericanWar RiskAgency,
14 Wall Street, New York,N.Y. 10005.Applicationson all other vessels to be submitted,with requiredattachments,to
the MaritimeAdministration,Attn: Director,Office of Subsidyand Insurance,Washington,D.C. 20590.)
.
I

Application for War Risk Insurance
Appendix A

oe

j

.~
ce

~
~
~~
~
E
~

II)

I

j
'5

T

~

Ii
~

.~
~

~
oS
~
if
~

m

~
~
.2
c
.2
..
u

I

.

i
<

M

t

l)

Co
c

GJ=

;;;~

JfI:

Appendix C
UNITED STATES OF AMERICA
Departmentof Transportation
MARITIME ADMINISTRATION

CERTIFICATE OF OWNERSHIP AND CONTROL BY UNITED STATES CITIZEN
APPLICANT FOR WAR RISK INS~RANCE
(Name)

(Titte)

of

am duly authorized to execute this certificate of
(Name of CO'J'OrBtion)

citizenship to comply with the requirements for obtaining War Risk Insurance to cover the vessels described in
Appendix 8

That

is a
(Name of corporation)

(Country)

corporationowned and controlledby
---

-

(Give sequenceof majority ownership and control of all owning or controlling corporations or other owners, if any, and
furnish the full information as to each, if above space is not adequate, continue on back of this form.)

a corporationorganizedand existingunder the laws of
(Country)
the majority (51 % or more) of the stock of which corporation is owned and controlled by citizens of
(Country)
citizens,

That of ~he stock interests shown above to be owned and controlled by
none is held beneficially for a citizen of another country.

Company Seal

(Country)

(Signature)
(Typed or printed name of signer)

Dated:

NOTE: The United States Criminal Code makes it a criminal offense for any person knowingly to make a false statement
or representation to, or to conceal a material fact from, arty department or agency of the United States as to any matter
within its jurisdiction (18 U.S.C. 1001 ), or to file a false, ficticious or fraudulent claim against the United States
(18 U.S.C. 287).
.

.

UNITED STATES OF AMERICA
OPTIONAL WAR RISK DISBURSEMENTS

INSURANCEENDORSEMENT

Attachedto and forming part of Interim Binder No. WRThis endorsement insures, as additional coverage, disbursements of the assured on board the vessel named in the
standard form of War Risk Hull Insurance Interim Binder, limited to consumable and subsistence stores, slop chests,
bar stock and bunker fuel in the total amount of
(See AppendixB)
. againstthe risks of
loss as a consequence of the actual or constructive total loss of the vessel insured, subject to the terms, conditions
and warranties set forth in the interim binder to which this endorsement is attached.
It is understood this insurance, made available as authorized under section 1203(c), Title XII, of Merchant Marine Act,
1936, as amended, is additional to the coverage provided in the War Risk Hull Insurance provision of the standard
Interim Binder of Insurance.

Further,it is understood and agreed that in the event of loss, payment of claim shall be limited to the actual value of
the disbursements lost as a consequence of the actual or constructive total loss of any vessel listed in Appendix B,
but said claim shall not exceed the amount of insurance provided in this endorsement.

UNITED STATES OF AMERICA
By Maritime Administrator
Acting for the Secretary
of Transportation

(Maritime Administrator)
Countersigned at New York, N.Y.,this
AMERICAN WAR RISK AGENCY
By

(Authorizedunderwriting agent)

day of

. 19.