Claim Form REQUEST INTELLIGENCE REVIEW Estimated Completion Time: 6–10 Minutes. All submissions are handled confidentially. Full Name Professional Role / TitleProfessional Role / TitleShip OwnerInsurerP&I ClubLegal CounselClaims ConsultantBrokerInvestorExecutive ManagementOther Company / Organisation Business Email Phone Number Case Name Case TypeCase TypeActive / Ongoing MatterClosed / Previously Resolved MatterPre-Claim AssessmentInternal Strategic Review Matter TypeMatter TypeHull & MachineryCargo DisputeInsurance CoverageCharterparty DisputeCollisionSalvageFraud / MisrepresentationCrew ClaimSanctions ExposureFinancial RecoveryOther Estimated Financial ExposureEstimated Financial ExposureUnder £100K£100K – £500K£500K – £1M£1M – £5M Provide a concise overview of the matter. Please include: • Incident or casualty • Key factual background • Current procedural or commercial status • Principal areas of dispute or uncertainty Current Stage of the MatterCurrent Stage of the MatterEarly AssessmentActive DisputeArbitrationLitigationSettlement NegotiationEnforcement / Recovery Jurisdictions InvolvedJurisdictions InvolvedYesNo UK, Singapore, Dubai, Panama Are multiple parties involved?Are multiple parties involved?YesNo If Yes Please State Reason Approximate Number of Parties Approximate Volume of DocumentationApproximate Volume of DocumentationUnder 50 pages50–250 pages250–1,000 pages1,000–5,000 pages5,000+ pages What materials are currently available?What materials are currently available?ContractsInsurance PoliciesEmailsWhatsApp / MessagesVessel LogsExpert ReportsFinancial RecordsWitness StatementsPhotographsAudio / VideoLegal FilingsOther Are there suspected contradictions or inconsistencies?Are there suspected contradictions or inconsistencies?YesNo Briefly explain the concern Geographical First Choice Geographical Second Choice Your Operation Involvement?Your Operation Involvement?0%50%100% How Do You Intend To Finance The Business How Much Free Capital Do You Have To Invest In K O Franchise? Bank Name Account Name Bank Address Account Number Sort Code Reference Name 1 Reference Address Reference Occupation Contact No. Reference Name 2 Reference Address Reference Occupation Contact No. In making this application for KO Franchise this is understood that an investigate report may be obtained. Contact may be with business associates, financial sources, and personal refernceswith regard to you credit status, character and general reputation. All information will be kept strictly private and confidential. In making this application for KO Franchise this is understood that an investigate report may be obtained. Contact may be with business associates, financial sources, and personal refernceswith regard to you credit status, character and general reputation. All information will be kept strictly private and confidential. I Agree I/We declare that the information provided in this application and in enclosed documents is true to the best of my/our knowledge and belief that no material face relation to this application has been knowingly withheld.I/We declare that the information provided in this application and in enclosed documents is true to the best of my/our knowledge and belief that no material face relation to this application has been knowingly withheld.I Declare Signed Full Name Signed Date Apply
