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Pleasure Craft

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NAME OF OWNER(required)

ADDRESS(required)

TELEPHONE OR MOBILE NUMBER(required)

EMAIL ADDRESS(required)

NAME OF YACHT(required)

EX-NAME OF YACHT(required)

MAKE, MODEL AND SPECIFICATION(required)

YEAR OF BUILT(required)

CONSTRUCTION MATERIAL

FIBERGLASS / GRP WOOD STEEL OTHER

REQUIRED INCEPTION DATE OF THE PROJECT (YYYY-MM-DD)(required)

EXPIRY DATE OF THE PROJECT (YYYY-MM-DD)(required)

ENGINE TYPE AND HORSE POWER(required)

ENGINE DESCRIPTION(required)

INBOARD OUTBOARD

LENGTH(required)

BREADTH(required)

DEPTH(required)

GRT(required)

PORT OF REGISTRATION(required)

REGISTRATION NUMBER(required)

VALIDITY(required)

VALUE OF YACHT HULL(required)

VALUE OF ENGINES (required)

OTHERS (PLEASE SPECIFY)(required)

TOTAL VALUE OF YACHT(required)

DO YOU REQUIRE THIRD PARTY LIABILITY COVER?(required)

YES NO

REQUIRED LIMIT FOR THIRD PARTY LIABILITY COVER(required)

DO YOU REQUIRE PASSENGERS LIABILITY COVER?(required)

YES NO

REQUIRED LIMIT PER PASSENGER(required)

REQUIRED LIMIT IN THE AGGREGATE(required)

REQUIRED LIMIT FOR PERSONAL EFFECTS(required)

REQUIRED LIMIT IN THE AGGREGATE FOR PERSONAL EFFECTS(required)

PURPOSE OF USE(required)

PERSONAL COMMERCIAL OTHERS

IF OTHERS, PLEASE SPECIFY(required)

TRADING WATERS(required)

DETAIL OF SAFETY EQUIPMENTS(required)

FIRE EXTINGUISHERS LIFE SAVING RADAR AID

OTHER DETAILS OF SAFETY EQUIPMENTS, PLEASE SPECIFY(required)

DATE OF LAST SURVEY (YYYY-MM-DD)(required)

DID ANY MAJOR WORKS BEING CARRIED OUT DURING THE SURVEY?(required)

YES NO

IF YES, PLEASE SPECIFY(required)

NAME OF PREVIOUS INSURER(required)

PLACE OF MOORING(required)

ASHORE AFLOAT

TYPE OF COVER(required)

INST. YACHT CL.328 INST. TOTAL LOSS ONLY CL.289

LOSS RECORD FOR THE LAST 5 YEARS(required)

ANY FURTHER DETAILS(required)

Message(required)

Disclosure of Material Facts: The Proposer whilst seeking terms for insurance are advised to disclose any information that may influence Underwriters in deciding whether or not to accept the risk and if so at what terms and conditions. Please be advised that any breach may amount to a material breach that may lead to denial of liability or making the contract void ab initio. Please review all the above information and click the tick box to confirm that the provided information is correct. (required)

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