Name of Vessel:
Type
Date of purchase
Tonnage (T.M.):
Price Paid:
When Built:
Do you wish to cover Mast, Spars, Sails and Rigging whilst racing?
Do you require a deductible in the policy:
What amount of THIRD PARTY LIABILITY do you require?
Do you wish to include liability to and of water skier(s):
If vessel is on charter, do you require liability to and of passengers?
Present Value:
Make of Engine(s)
Date:
State if:
Marine Engine
Conversion
Outboard
Jet
Designed Maximum Speed
Is the Engine Turbo charged?
Fuel Used For Main and Auxiliary Machinery
Is Calor or Other Bottled Gas Used?
If So, State Material Of Delivery Tubing
What fire extinguishers are kept on board?
No:
Type:
For vessels with inboard machinery exceeding 17 Knots.
(a) Proponent full name
(b) Proponent address
(c) Office telephone Number
(d) Proponent Occupation
(e) Nationality
How long have you been accustomed to the land craft?
Will the vessel be used for private pleasure purposes only?
State period for which the vessel is to be insured
(a) in commission
(b) Laid-up
Where is the vessel moored when in commission:
Where will she be Laid-up:
Will the vessel be Laid-up:
Ashore
In mud berth
Afloat
Marina
What accident have you had during the past five years in connection with any vessel you have sailed or owned?
Have you ever had an Insurance for any vessel
Declined
Cancelled
Renewed only at an increased rate
Please state your present No Claim Bonus allowance
Vessel’s Port of Registry or Home Port
Proponent Signature
Date
Signed: (If Joint Owners)
Date
IMPORTANT NOTICE:
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