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Name & Surname*
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ID card number*
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Date of birth*
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Address
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Phone number*
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Mobile number*
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Email Address*
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Details of any incidents or claims you have had in the past 10 years*
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Please provide us with the following details of your vessel
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Model*
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Builder
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Max speed*
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Material of hull*
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Length*
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Beam
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Draft
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When built*
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When purchased (in euro)
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Price paid*
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€ |
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Details of any tenders or dinghies to be covered (including serial numbers for any outboard motors)*
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Vessel location and type of mooring when in commission*
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Vessel location and type of mooring/storage when laid-up*
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Period vessel laid up (if any)*
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Cruising area to be covered
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Engine model and make
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Engine year of make
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Fuel type
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Is the engine inboard or outboard?
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What kind of insurance do you require?
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Type of cover
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Total Sum to be insured (inclusive of Hull, Machinery, Equipment and Tender)
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€ |
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Details of your current insurance
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Current Insurer
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Insurance period
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From
To
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