(619) 222-1944

Electronics Application

  • Vessel Details

  • Electronics Details

  • Claims

  • Please attach a copy of the most recent survey, including a schedule of the electronics.
  • I HEREBY DECLARE THAT THE PARTICULARS AND ANSWERS GIVEN IN THIS APPLICATION ARE IN EVERY RESPECT TRUE AND CORRECT AND THAT I HAVE NOT WITHELD ANY INFORMATION WHICH COULD INFLUENCE THE DECISION OF THE COMPANY IN REGARD TO IT’S ACCEPTANCE.
  • This field is for validation purposes and should be left unchanged.
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