MARINE INSURANCE

Name*

Surname*

Contact Email*

Contact Number (Mobile)*

Occupation*

ID Card No*

Date of Birth*

Boat Experience (Years)*

Current Insurer (If applicable)

Make*

Type*

Year of Build*

Maximum Designed Speed (Knots)*

Material*

Length*

Navigating Waters*

UseNot ApplicablePleasureCommercial

Engines

Fuel

Type

Horse Power

Value

Engine 1*

NoneDieselPetrol

NoneInboardOutboard

Engine 2

NoneDieselPetrol

NoneInboardOutboard

Engine 3

NoneDieselPetrol

NoneInboardOutboard

From*

To*

Location*

From*

To*

Location*

Current Market Value

Tender

Outboard Motor of Tender

Road Trailer

Personal Effects

Vessel (incl. inboard machinery & equipment)

Loss History (Last 5 Years)

Optional Extensions RequiredCharterOutboard Motors Dropping Off or Falling OverboardRacing RisksRoad TransitWater Skiing LiabilityNone

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