Yacht pi insurance quotation form

1THE SHIP

2SHIP CHARACTERISTICS

3USE OF THE SHIP

4CONTACT DETAILS

Ship Name*
Ship Value*
Please enter a number greater than or equal to 100000.
Current Value+ Equipment + Personal Effects
Currency*
- EUR
- USD
- GBP
Navigation Limits*
Please describe your sailing trip*
We are sorry, we are not able to find a cover yet for your ship.
Effective date of coverage*
DD slash MM slash YYYY
Files

Drop files here or

Max. file size: 10 MB.

DROP HERE: -A copy of the “Certificate of Registry”
– Recent Survey
-….
Settings

You can skip this part if you provide us documents of the ship
If not, please fill the fields below.
If any modification has been undertaken (refit, flag,…) please fill the corresponding fields.
Flag

Boat Builder

Building Year*

If your ship is more than 12 years, Insurance companies may require a recent survey attesting her good condition and Market Value
Model

Gross Tonnage

Engine Builder

Engine year of contruction
Engine Number(s
Total Horse Power
Tender Number(s) ?
Motorised Water Toy Number(s)
Toys Model

Home Port*

Use*

Private

Charter

Rental
Crew Member Number*
Permanent + seasonal
Do you need a quote to insure the crew to be compliance with MLC2006?*

YES

NO
See Details
Do you need a quote to insure the crew ?*

Yes

No
See Details
Permanent Payroll*
Permanent Crew Number*
Seasonal Crew Number*

Number of claims (over the last 5 past years):*
If YES
-Year ; Desciption ; Amout
Name / Company*

Position*
Owner/ Company Address
Your email*

Telephone*
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