Sportfishing/Charter Vessel Application

If the vessel is owned by a Private or Limited Company please state the name of the Company and the beneficial owners. If the yacht is owned by more than one Person, a separate proposal form must be completed by each part owner.

About the Owner
Insured's Full Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone (work)*
Email*
Occupation*
Beneficial Owner (if not the Insured)
Please list all beneficial owners and specify operators- only operators approved by us will be covered to operate vessels owned in corporate or trust names.
Length and nature of boating experience*
Give details, including qualifications and previously owned vessels.
Have you had any accidents, claims or losses in connection with any vessel you have sailed, owned or was under your control in the last 5 years?
Please provide full details, including dates and amounts paid*
Have you or any person you have allowed or may allow to use your yacht, ever been charged with or convicted of any offence involving dishonesty or any other offence which might affect our assessment of the risk?
Please provide full details*
Have you ever had Insurance declined, non-renewed or cancelled?
Please provide full details*
Names of other principal operators*
Previous Insurers*
Policy Renewal Date*
Date Format: MM slash DD slash YYYY

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About the Vessel
Name Of Vessel*
Type (eg. Motor Yacht)*
Date of Purchase*
Date Format: MM slash DD slash YYYY
Manufacturer
Model
Year of Build
Port of Registry*
Flag*
Class
Hull Identification Number
Price Paid
Current Market Value
Length
Beam
Draft
Tonnage
Material of Hull
Material of Mast
Engines (make)
Number & Horse Power
Maximum Design Speed
Surface Drives
Has the Vessel been professionally surveyed in the last three years?
Surveyor's Name
Copy of the Survey*
Have all the survey recommendations been complied with?
Is the Yacht subject to finance or mortgage?
Please advise amount of loan and name of lender*
Details of fire extinguishing system
Currency
- USD
- EUR
- GBP

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Use of Vessel
Details of use
- Private and Pleasure only
- Skipper Charter Use
- Bareboat Charter Use
Please specify number of weeks*
Racing or Regattas
Please provide details, including the values of the masts, spars, sails and rigging*
Mooring location Home Port - Spring / Summer*
Mooring location Home Port - Fall / Winter*
In Commission months
Lay up period
Will there be any towed vessels?
Please provide full details of period, name and location of shipyard*
Owner / Skipper Information
Owner / Skipper Information
Name of owner / skipper
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There are no Owners / Skippers.
Maximum number of owners / skippers reached.
Crew Details (if applicable)
Number of Crew
Permanent Crew including Captain
Temporary Crew
Details of any U.S. Nationals
Captains Qualifications*
Captains CV and License*
Must be submitted to Underwriters for their agreement
Drop files here or
Has the Captain had any accidents, claims or losses in connection with any vessel under their control?*
Please provide full details*
Declaration
I declare that the information provided in connection with this proposal, whether in my own hand or not, is true and I have not withheld any material facts*. I understand that non-disclosure or misrepresentation of a material fact* may entitle underwriters to void the insurance.

*A material fact is one likely to influence acceptance or assessment of this proposal by underwriters; if you are in any doubt as to whether a fact is material or not you must disclose it.

This proposal and the information provided in connection therewith contain statements upon which underwriters will rely in deciding to accept this insurance. Should a contract of insurance be concluded this proposal will form the basis of the insurance.
Signature*
Name*
First Last
Date*
Date Format: MM slash DD slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Name of owner / skipper
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There are no Owners / Skippers.

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Vessel	Home Port	Size of Vessel	Position Held	Dates

Year	Date of Loss	Amount Involved	Insurer	Amount of Claim

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About the Owner

About the Vessel

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Use of Vessel

Owner / Skipper Information

Crew Details (if applicable)

Declaration

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