Hull and Machinery Proposal Form

Hull and Machinery Proposal Form

Assured Contact Details:

Assured:
Telephone:
Address:
City:
Country:
e-mail:

Manager Contact Details:

Manager:
Telephone:
Address:
City:
Country:
e-mail:

All correspondence should be sent to the: Assured Manager Other (please specify)

Has the Assured or Captain suffered any claims in the last 5 years? If so, please detail below:

The Crew

Please state who will be conducting day-to-day operation of the vessel:

Please describe all relevant yachting experience of the operator. Please detail any relevant qualifications:

Number of permanent crew: Number of temporary crew:

The Vessel

Name:
IMO number (if applic.)
Gross Tonnage:
Passenger Capacity:
Max. Design Speed (MDS):
Build Date:
Purchase Date:
Purchase Price:
Current Market Value:
Builder and model name/no.:
Engines (number, brand, total HP, and whether surface drives):
Hull and Superstructure construction material:
Mast size and material:
Type and Details of Fire Extinguishing System:
Class Register (please note MCA if applicable):
Ice Class:
Port of Registry:
Flag:
Length/Breadth/Draft: / Length: Breadth: Draft:

Vessel Use

Required Cruising Range:

Where is the vessel permanently moored?

Will the vessel be in commission for 12 months? If otherwise, please specify lay-up period/location:

Circle as appropriate: Private and Pleasure Only Skipper Charter Other (please specify)

Is Water Sports cover required?YesNo

Is coverage for towed vessels required – please specify if so?

Is Personal Accident cover for crew required?

YesNo

If ‘yes’, please fill in attached personal accident form.

Is War Risk and/or Piracy cover required?YesNo

Sums Insured Requirements

Currency:USDEURGBPOther:

Yacht
Tenders
Equipment
Personal Effects (ex. Fine Art)
Fine Art

Please provide details of tenders included in the above, if applicable:

Declaration

Have you ever had insurance declined, non-renewed or cancelled? Please provide details if so:

Have you, or any person allowed or who may be allowed to use the yacht named in this document, ever been convicted of any crime, excluding road traffic offences? If ‘yes’, please provide details:

Is the Yacht subject to finance or mortgage? Please detail amount of loan, and name of lender if so:

Please note that an insurance quotation based on the information provided or connected with this proposal form will be given on the understanding that the information held therein is true, complete, and that there are no further material facts* that need to be provided.Misrepresentation/non-disclosure may result in the voidance of your insurance.

Signed: Print Name:

Date: