Marine Insurance Proposal Form

Forenames

Surname

Address

Zip/Postcode

Email Address

Tel (home)

Tel (Work)

Tel (Mobile)

Occupation: (Director is not sufficient)

Date of Birth

1 2 3 4 5 6 7 8 9 10+ Boating Experience (years)

In which craft?

Relevant Qualifications

Particulars of Vessel

Name

Type or class

Hull serial Number (See note 1)

Builder's name

Country of Registration / Flag:

Year Built

    No Yes Is vessel a conversion?

If YES was it converted by professional or amateur. Give full details of conversion and by whom, with date:-

Length

Beam

Draft

Sail Area

Hull Material

Date of last survey

Surveyor's Name

Date boat purchased

Price paid (include currency)

Particulars of Engine(s)

Theft cover for outboards will not apply without a serial number.

    No Yes Are outboards permanently locked to transom
or stored in locked premises when not in use?

Maximum designed speed of vessel - specify calibration.
If over 17 knots, please note the contents of the Speed Boat Clauses

Are the following areas fitted with an automatic or remote fire extinguishing system?

    No Yes Engine room(s)

    No Yes Tank Space

    No Yes Galley

State number and make of fire extinguishers carried:

Hand

Remote

Automatic

Gas System

If liquefied petroleum gas (LPG) is used, is the:-

    No Yes Cylinder kept in self draining cockpit locker

    No Yes Delivery tubing copper or European standard armoured type

Cruising Range

Please give full details of the cruising range undertaken or required *

    No Yes Do you intend to sail single handed?

Do you require cover for : (please state yes or no for each)

    No Yes Private and pleasure only

    No Yes Living on Board

    No Yes Hire

    No Yes Charter

    No Yes Wreck Removal and Salvage

    No Yes Netting/Potting

    No Yes Demonstration

    No Yes Racing

    No Yes Water Skiing

    No Yes Night Navigation

Details of Moorings

Moored at

Type of Mooring

Period vessel in commission:

From

To

Period vessel laid up

From

To

Laid up at

    Afloat Ashore 

Sums to be Insured

Enter numbers only !!

Hull/Machinery/Gear/Equipment only (See Note 4) *

Tender/Dinghy/Liferaft

Outboard Motor

Trailer

Personal Effects (Maximum £100 any item unless specified)

Navigation Equipment (Maximum £100 any item unless specified)

Mast/Spars/Sails/Standing and Running Rigging (If racing risk required)

Other

 Total Sums Insured

Sterling US Dollar Euro Other - Specify Specify currency

Other Currency

Third Party Liability level
Currency is assumed to be as above
Maximum liability within the EU is £2m Sterling or Euro equivalent. Outside EU third party cover can be quoted on request.

When do you require cover to commence

My present policy is with

yearsCurrent No Claims Bonus entitlement (evidence required)

Please complete the following if any cruising range is outside of Europe

What arrangements have you made and what will you do to safeguard your boat in the event of a Named Hurricane or Tropical Storm warning being issued? Please be specific and state what additional anchors/lines will be deployed, items removed etc:-

Where will your vessel be kept in such an event?:-

What alternative arrangements have you made if your original plan becomes unworkable? Example: If you are away from your homeport:-

Who, if other than yourself, will be responsible for preparing your vessel for a storm?:-

    No Yes Have you ever had to prepare for a hurricane before?

If YES, when and where?:-

It is understood and agreed that in the event of a named Hurricane or Tropical Storm warning, I/We will make every reasonable effort to secure the above vessel and/or it's equipment, including but not limited to removing/stowing of sails, bimini canvas, loose items, outriggers and antennas.

Comments

Please Select Magazine Advert Internet Advert Internet Search Engine Word of Mouth Returning Customer Other How did you find us?

Please Specify

Any Comments you wish to add?

Declaration

    No Yes Insurance on any vessel declined or Special Terms imposed

    No Yes Any accident or losses in respect of any vessel

    No Yes Ever been charged with or convicted of any offence involving dishonesty

    No Yes Are you the sole owner of the vessel

    No Yes Is the vessel the subject of any mortgage or financial agreement

I hereby declare that all the information I have given on the proposal form is correct at the time of signing and that I understand I would be obliged to inform insurers of any changes that occur during the policy period and that failure to do so could invalidate this contract insurance. I also declare that if anything on this form was written by another person he/she acted as my agent for this purpose.

Note: Submitting this form does not bind the proposer to complete this insurance.

The Company reserves the right to decline any proposal.

The Proposer should keep a record of all information supplied to the Insurer for the purpose of entering into the Contract, and a copy of this Proposal will be supplied on request, within a period of three months after completion.

Edward William Marine Services SL is a Spanish Registered Insurance Agent and as such is not authorised or Regulated by the UK Financial Services Association and is not covered for compensation under the UK Financial Services Compensation Scheme (FSCS)