Insurance Application Form

QUOTATION REQUEST FORM FOR YACHTS

OWNERS INFORMATION

Company Name

Address

Telephone

VAT

Tax Office

Name of UBO (Owner)

Nationality

Date Of Birth

HULL

Boat Name

Type

Builder

Hull No

Flag

Registration port & No.

Year built

Material

Length overall in m

Beam in m

Draft in m

Classed By

Gross Tonnage

Cabins

ENGINES

Engine type

Builder

Number of engines / hp per engine

Year built

Fuel

Max. speed in knots

AGREED INSURED VALUE

Insured capital (in €)

VAT

OTHER INFORMATION

Use of boat

Period of Insurance

Name of Captain

Experience

No. of Crew

No of guests

Navigations Limits

Mooring type and area

Laid up area and period

Last date of maintenance

Fire Extinguishers

Other security measures

PREVIOUS INSURERS

Insurance Company

Claim History on last 5 years

Present or previously owned yachts

Seabobs/Other toys

REQUEST FOR

THIRD PARTY LIABILITY

SKIER’S

P&I

W&S

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