Fishing Nets Application

Full Name of Assured(s)
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email Address*
Phone*
Loss Payee
Vessel Name*
Vessel Details
Year Built
Construction
Length
Gross Tonnage
Vessel Type*
Market Value
Operations
Type of Operations
Period of Operations
Trading Warranty
Net(s) Details
Age of Nets
Value of Nets
Date of Last Vessel Survey
MM slash DD slash YYYY
Next Scheduled Vessel Survey
MM slash DD slash YYYY
Date of Last Net Survey
MM slash DD slash YYYY
Next Scheduled Net Survey
MM slash DD slash YYYY
Most Recent Vessel and Net Survey
NOTE: A current survey of the vessel and the insured nets, where said nets are not new, shall be provided to Underwriters. Please attach a copy of the most recent vessel and net survey.
Max. file size: 50 MB.
Previous Insurance Record
In respect of this, or any other vessel owned or operated by you, please advise of any claims or incidents (paid or oustanding) in the past 5 years which may result in a claim
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.
Signature*
Date
MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

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Vessel Details