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Quotation form for marine insurance
Page
1
of 5
Information about the subscriber
Title
*
Please select
Mr
Mrs
Miss
First name
*
Last name
*
e-mail
*
Phone
*
Town of residence
*
Town zip code
*
Country of residence
*
Nationality
*
Date of birth (dd/mm/yyyy)
*
Profession
*
Next
Information about the vessel
Yacht is used for :
*
Please select
Charter without skipper
Charter with skipper
Private without charter
Vessel name
*
Builder name
*
Model
*
Length over all in meters
*
Year built
*
Material of hull
*
Home port
*
Flag
*
Navigation area
*
Past claims "All in the past 5 years"
*
If vessel laid up
*
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Next
Engines
Make
*
Number of engines
*
Please select
1
2
3
4
5
6
Horse power each
*
Engine year built
*
Fuel type
*
Please select
Petrol
Diesel
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Next
Crew
Crew type
*
Please select
Permanent
Seasonal
Permanent & Seasonal
Number of permanent crew
Number of seasonal crew
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Next
Sums to be insured
Hull and Machinery
*
Increased value
Third Party Liability
*
Water skieers liablity
*
Yes
No
Personal effects
*
Tenders and other « toys » ?
*
You can ad any additional info bellow
Veuillez saisir les caractères
*
Cela nous aide à éviter les spams, merci.
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