Libra HCV & GIT Needs Analysis — LB-NA-HCV-002 Rev 2.1

1CLIENT & ENTITY IDENTIFICATION

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Registered Entity / Trading Name *

Previous Trading Name(s)

Company Registration No. (CIPC)

VAT Registration No.

DIRECTOR / MEMBER DETAILS

Director 1 — First Name

Last Name

ID Number

Director 2 — First Name

Last Name

ID Number

Director 3 — First Name

Last Name

ID Number

CONTACT & ADDRESS DETAILS

Contact Person (Primary) *

Capacity / Role

Email Address *

Telephone Number *

Cell Phone Number

Alternative Contact

Alt Contact — Capacity / Role

Alt Contact — Email & Telephone

Business Physical Address

Province

2STATUTORY DISCLOSURES & POPIA CONSENT

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Disclosure by Libra Insurance Brokers (FSP 9131): We are an authorised Financial Services Provider licensed by the FSCA. We act as your intermediary and may receive commission and/or fees from insurers. Our FSP licence, conflict of interest policy, and compensation disclosure are available on request.

POPIA Consent: By completing and signing this form, you consent to the collection, processing, storage, and sharing of your personal and commercial information with third-party insurers, reinsurers, and industry bodies solely for the purpose of obtaining quotations, administering your policy, and fulfilling our regulatory obligations.

I have read and understood the FAIS disclosure above I consent to the processing of my information (POPIA) I consent to my information being shared with insurers for quotation purposes I consent to information being verified against required databases

3OPERATIONAL SCOPE & AREA OF OPERATION

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Primary Use / Type of Operation

Transport Company Transport Broker Owner of the Goods

Primary Routes Operated (within SA — list all provinces)

If owner of goods — Are you the owner of goods transported?

Yes No Mixed

TRAVELLING DISTANCES — PERCENTAGE SPLIT

Haulage Category	Distance Range	% of Operations
Short haulage	Up to 100 km
Medium haulage	101 km – 400 km
Long haulage	401 km – 800 km
Extremely long haulage	801 km – 2 000 km
Into neighbouring territories / cross-border	Over 2 000 km

Travelling distance percentages should total 100%.

CROSS-BORDER OPERATIONS

Do you operate cross-border / outside the borders of SA?

Yes No

If yes — list all countries/corridors you operate in

4FLEET PROFILE & ASSET INVENTORY

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MOTOR/FLEET — 3-YEAR HISTORY OF ORGANIC GROWTH

Attach the full fleet list. List all vehicles to be noted. Finance houses to be noted for endorsement.

Year	HCV		Trailers
Year	No. of Vehicles	Full Value (R) incl. extras & VAT	No. of Vehicles	Full Value (R) incl. extras & VAT

VEHICLE INVENTORY

Type	Make & Model	Year	Reg. No.	VIN/Engine No.	Reg. Owner	Cover Type	Value (R)	Extras (R)	Finance House

FLEET SUMMARY & VEHICLE OPERATIONS

Total Number of Vehicles

Total Fleet Value (excl. non-standard accessories, incl. VAT) R

Are any vehicles financed / subject to a Notarial Bond?

Yes No

If yes — finance houses

Are any vehicles hired out / leased to any other party?

Yes No

If yes — is contractual responsibility and accountability clearly documented?

Yes No

Do you hire in / lease in any vehicles? (Interest to be noted)

Yes No

Are any vehicles owned or operated by anyone other than you?

Yes No

Does your company perform its own vehicle servicing (incl. modified bodies, e.g. refrigerated units)?

Yes No

Does your company perform its own accident repairs?

Yes No

Are any vehicles used for abnormal loads or requiring special permits?

Yes No

Any other material facts to disclose?

Yes No

If yes to any above — provide full details

5DRIVER RISK PROFILE

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DRIVER EMPLOYMENT & PAYMENT STRUCTURE

Are you an owner-driver?

Yes No

Are drivers salaried?

Yes No

Are drivers paid per delivery?

Yes No

Are drivers paid per kilometre?

Yes No

DRIVING BEHAVIOUR & CONTROLS

Driving hours policy — Do you drive at night?

Yes No

If yes — confirm the general rule (e.g. drivers stop driving from 22:00 to 04:00)

Driving hours policy — If drivers get fatigued during usual working hours, what is the protocol?

Do drivers always drive the same vehicle/horse and trailer? Are specific drivers assigned to specific vehicles?

Yes No

Do drivers complete pre-start vehicle checklists?

Yes No

If yes — confirm format (digital / application or physical documentation)

DRIVER VERIFICATION & COMPLIANCE

Obtain full CV, check previous employment and criminal record?

Yes No

Are drivers subjected to random polygraph tests?

Yes No

Previous employment references checked and records verified?

Yes No

Validate / Verify Driver licence and PrDP before employment?

Yes No

Are driver documents (PrDP, DDC licences) monitored and tracked for expiry and renewal?

Yes No

Do you maintain copies of all driver documentation (Passport, ID, PrDP, DDC licences)?

Yes No

Do you employ any foreign national drivers?

Yes No

If yes — what nationality?

Do foreign drivers hold a legally accepted PRDP equivalent to operate in SA and areas of operation?

Yes No

Do drivers undergo any medical checks, apart from those conducted for licencing?

Yes No

DRIVER TRAINING PROGRAMMES

Do you have a driver training programme in place?

Yes No

If yes — type

Internal External

If external — details of trainer/s

Is training on an ongoing / continuous basis?

Yes No

FORMAL TRAINING TOPICS COVERED — Submit copies of certificates if yes

Correct operation of vehicle being driven

Yes No

Security of the vehicle and trailer

Yes No

Taking rest periods as required by law

Yes No

Hijacking prevention methods

Yes No

Procedures following an accident

Yes No

Correct securing of the load

Yes No

Firefighting measures / extinguishers

Yes No

First aid

Yes No

6GOODS IN TRANSIT (GIT) & CARGO EXPOSURES

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Require goods in transit cover?

Yes No

CONVEYANCE LIMITS

A) Maximum Value — Any One Load (R)

B) Annual Haulage Fees — Previous Financial Year (R)

In plain terms — What does your actual annual haul look like? (what you carry, loads per year, value per load)

C) Estimated / Projected Annual Haulage Fees — Current Year (R)

* Insurers reserve the right to audit the numbers declared, at any stage.

DESCRIPTION OF GOODS & PERCENTAGE OF LOAD CARRIED — Total should equal 100%

Commodity

%

Commodity

%

Foodstuff (excl. tinned goods)

Liquor / Alcoholic Beverages

Foodstuff (incl. tinned goods)

Tinned Fish

Tobacco (raw)

Hazardous chemicals

Electrical appliances

Electronics / Electronic Goods

Building materials

Heavy equipment

Bricks / pavers

Plant & Machinery

Steel products

Sand / stone / aggregate / cement

Fertilizer

Fragile / white goods (incl. Hisense)

Motor Vehicles (Car carrier)

Explosives

Motor Spares and Parts

Gas Bottles

Fuel, Petrol or Diesel

Household / office removals

Gas (Tanker Trailer — LPG, CNG or LNG)

Furniture (new)

Shipping containers

Furniture (used)

Game & Livestock

Clothing & Footwear

Agricultural produce

Refrigerated / frozen goods

Fresh produce

Dangerous goods (SANS 10228)

Coal

Solar and Backup equipment

Cigarettes

Abnormal Loads

Tyres

Copper

Tyres & Rims

Cobalt

If other — provide description

Containerised goods

Yes No

If yes — is the sum insured / limit of liability sufficient to include the value of the actual container?

Are you / your employees responsible for loading, off loading and packing consignments?

Yes No

7SUBCONTRACTOR / CONTINGENT EXPOSURES

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Do you make use of any sub-contractors?

Yes No Occasionally

Do you make use of any owner-drivers?

Yes No Occasionally

Estimated Annual Haulage Fees Paid to Sub-Contractors (R)

Commodities Carried by Sub-Contractors

Sub-Contractor Areas of Operation

Do your subcontractors further re-sub any loads?

Yes No

Insured's responsibility: Properly vet all sub-contractors and ensure their GIT cover is active, adequate, and not inferior in any material respect.
Insured's responsibility: Written contracts of agreement clearly depicting all terms and conditions of the full chain of custody must be in place, agreed to, and signed PRIOR to any losses.

8HAZCHEM & SPECIALISED RISKS

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Are any hazardous or dangerous goods transported? (SANS 10228)

Yes No

If yes — Indicate the UN class / description of hazardous goods below:

Class	SANS 10228 Hazard Class	Classification Description	Yes / No
1	Explosives	Commercial blasting agents, mining explosives, and detonators	Yes No
2	Gases	Liquefied petroleum gas (LPG) and compressed oxygen cylinders	Yes No
3	Flammable Liquids	Petrol and diesel in bulk tankers, or industrial solvents	Yes No
4	Flammable Solids	Sulphur flakes and alkali metals like sodium or potassium	Yes No
5	Oxidizing Substances & Organic Peroxides	Ammonium nitrate fertilizers and pool chlorine	Yes No
6	Toxic & Infectious Substances	Agricultural pesticides and clinical medical waste	Yes No
7	Radioactive Material	Medical isotopes and industrial radiography sources	Yes No
8	Corrosive Substances	Industrial acids (such as sulphuric acid) and caustic soda	Yes No
9	Miscellaneous Dangerous Goods	Bulk lithium-ion batteries and elevated-temperature substances like hot bitumen	Yes No

Any haz goods stored at any of your business addresses?

Yes No

Above or underground tanks?

Above Underground

Any vehicles used for abnormal loads or requiring special permits?

Yes No

If yes — describe abnormal load type / permit details

Any other specialised or high-risk features to declare

9RISK MANAGEMENT & SECURITY

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COMMUNICATION, SAFETY & SECURITY DEVICES — Provide full details where yes is selected

Cellular phones

Yes No

Registration number painted on roof

Yes No

Dry powder fire extinguishers (minimum 9 kg required on all HCVs)

Yes No

Automatic engine cut-out / 'Limp mode' functionality

Yes No

Trailer overloading devices

Yes No

On-board cameras / dashcams (cab / forward or rear facing)

Yes No

Own 24-hour manned control room? (NOT telematics/tracking company or supplier — OWN)

Yes No

Tracking and recovery system

Yes No

Tracking / Telematics Provider / System

Double tracking on any vehicles in fleet?

HCV Trailers LDV PMV

Trailers fitted with tracking / recovery?

Yes — All Yes — Some Tankers No

Other communication / safety devices — specify

If yes to any above — provide full details

PREMISES SECURITY & OVERNIGHT PARKING

Security Measures — Full Detail

10CLAIMS HISTORY & CONTINUITY

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INSURANCE HISTORY — CURRENT & PREVIOUS

Status	Name of Insurer	Policy Number	Period of Insurance
Current
Previous
Previous

INSURANCE HISTORY FLAGS — Provide full details if yes

Has any insurer declined to quote?

Yes No

Has any insurer cancelled your insurance?

Yes No

Has any insurer refused to renew your policy?

Yes No

Was cover with any insurer uninterrupted?

Yes No

Has any insurer imposed special terms or conditions?

Yes No

If yes to any above — provide full details

Reason for change of insurer / broker (if applicable)

PREVIOUS MOTOR INCIDENTS — Claimed for or not — Past 3 years — Attach current insurer record

Date of Loss	Vehicle Type	Vehicle Reg.	Description of Loss	Settlement Amount (R)

PREVIOUS GIT INCIDENTS — Claimed for or not — Past 3 years — Attach current insurer record

Date of Loss	Type of Goods Carried	Description of Loss	Settlement Amount (R)

11CLIENT OBJECTIVE

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New Quote Renewal Comparison / Review Alternative Policy Structure (Conv. / Non Conv.) Alternative Cover / Rate Options

12COVER REQUIRED — QUOTATION INSTRUCTIONS

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PLEASE QUOTE ON (tick all applicable)

BUSINESS ALL RISKS

Require Business All Risks cover?

Yes No

Item Description	Value (R)

MECHANICAL BREAKDOWN TOWING

Require mechanical breakdown towing cover?

Yes No

Description — specific vehicles or number of units per vehicle type

OBJECTIVES & QUOTATION NOTES

Client's Objective with this Renewal / Placement

Affordability / Monthly Premium Guidance (R)

Preferred Excess — Own Damage

Preferred Excess — Third Party

Specific Requirements, Endorsements, Conditions, or Notes for Insurers

DCLIENT DECLARATION

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I/We declare that the statements and particulars in this needs analysis are true to the best of my knowledge, understanding and interpretation, and that I/We have not intentionally misstated, suppressed, or omitted any material facts. I/We understand that a material fact is any fact that will influence the acceptance of the risk. I/We undertake to inform Libra Insurance Brokers of any material alteration of these facts whether occurring before or after completion of the contract of insurance. I/We acknowledge that failure to disclose material information may result in a policy being voidable or a claim being prejudiced. I/We consent to the use of personal information contained in this document for the intermediary rendering advice and intermediary services, and to such information being shared with insurers, reinsurers, and authorised industry bodies for underwriting, placement, claims assessment, and regulatory compliance.

Signed at

On (Date)

Full Name & Surname

Designation / Capacity

Signature of Client / Authorised Representative

Date

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NEEDS ANALYSIS — HEAVY COMMERCIAL VEHICLE & GOODS IN TRANSIT