Proposer Details

Your Name & Surname(required)

ID Number (required)

Date of Birth (required)

Occupation

Contact Number

Your Email (required)

Boating Experience

Present Insurers

Vessel Details

Name

Type

Year of Build

Maximum Designed Speed

Material

Length

Engines (inc. HP)
PetrolDiesel

Navigating Waters

Use

In Commision Period

From

To

Location

Laid Up Period

From

To

Location

Value to be insured (current market value)

Vessel (inc. inboard machinery and equipment)

Outboard Motor(s)

Tender

Outboard Motor of Tender

Road Trailer

Personal Effects

Loss Experience

Loss History (Please provide up to 5 years loss experience)

Optional Extensions Required

 Road Transit Propeller Fouling Outboard Motors Dropping Off or Falling Overboard Charter Water Skiing Liability Racing Risks (Sailing Boats only)

For Racing Risks please state New Replacement Value of
Masts Spars Sails Standing and Running Riggings

Please enter the characters you see in the field provided