Yacht & Pleasure Craft Application

Transcription

1 Yacht & Pleasure Craft Application I. Applicant Information Name Date of Birth Address Telephone Occupation 1. Have you or any member of your family normally residing with you, or directors where the Proposer is a company, ever been convicted of any offenses? 2. Have you or any person listed above suffered from diabetes, epilepsy, heart condition or any other physical or mental disability, infirmity or disease, or had any condition controlled by drugs? If yes, to either question give details II. Boat Handling Experience and Insurance Record What are your special qualifications for Boat handling? e.g. Yacht Masters Certificate How many years have you been the owner or crew of this type of Craft? How many incidents have happened during the past 5 years in connection with any vessel you have sailed or owned? Have you previously insured any vessel? If yes, state which insurer. Have you ever had insurance on your boat, cancelled? refused at renewal? Please state circumstances.

2 III. Period of Insurance Period of Insurance 12 months from IV. Berth Will the vessel be based - Ashore when not in use? Afloat on moorings? If at a marina, state name. If not a marina give details of type of mooring and precise location. V. Vessel in Transit Do you require the vessel to be insured during any inland transits? If yes, please give details. VI. Hurricane Precautions How and where will the vessel be protected in case of a hurricane warning? VII. Laid up out of Commission Will the vessel be laid up ashore out of commmision for part of the year? If yes, please give dates and location where vessel will be stored. VIII. Navigating Limits State cruising range required. IX. Use of Vessel Private pleasure only? If no, state intended use. Do you have a full time professional Master? If yes, please give details of his sailings experience with this type of boat, and which particular boat. Will any other person be allowed to be in charge? If yes, give details.

3 Will the vessel be sailed single-handed? Will the vessel be used for waterskiing, aquaplaning or any similar sport? If yes, give details (parent vessel or tender) Will the vessel be involved in racing? If yes, give details X. Hull Details Name Vessel Type/Class Serial Number or Registration Number. Length Overall Beam Material Hull Max. number of Passengers Max. designed speed with present engine(s) Engine Type Inboard Outboard Single Twin Engine Make/Model Engine Serial Number(s) Horsepower of each

4 Fuel Used Year of Make If inboard engine(s). Are they the original enigines installed by the builder of the Hull? If no, give details or attach note with details. Has the vessel proposed for insurance been subject to: a) Conversion b) Modificaiton c) Amateur Construction? If yes, give full details. What system is used for: Lightning Cooking Heating Details of Fire Enxtinguisher System Has the vessel been surveyed by a qualified surveyor? (if yes, please provide copy of report) XI. Details of Dinghy/Tender to parent vessel Length I.D./Serial s Identification/Serial Number Details of any auxiliary outboard motors not already shown above XII. Details of Trailer I.D./Serial XIII. Liability to Third Parties Please state limit of Indeminity required Do you require cover in respect of liability to and of water skiers or persons engaged in similar water sports from your boat? (Restricted limit may apply)

5 XIV. Schedule of Insurance Description Value to be Insured Date Purchased Purchase Price Hull & Equipment Including Inboard Engine Outboard Motor(s) to Parent Vessel Special Equipment attach value list Dinghy/Tender to Parent Vessel (must be permanently marked with name of parent vessel) Outboard Motor(s) to Dinghy/Tender Trailer Personal Effects N/A N/A Total to be Insured N/A N/A XV. Racing Risk Extension (If required for sailing vessels) Please state total replacement value of sails, masts, spars, standing and running ringing. XVI. Voluntary Deductible Do you wish a voluntary deductible in addition to any compulsory deductible? If yes, please indicate the additional amount required. XVII. Lender Information Is the vessel subject to loan? If yes, please state the Loan Amount, Loan Period in Years and Name of the Lender or Bank. XVIII. Additional Information Any other information which is likely to influence the Company in regard to this proposal? Declaration I hereby declare that, to the best of my knowledge and belief, the particulars and answers are true and correct and that I have not withheld any information which is likely to influence the decision of the Company in regard to this proposal. Signature of Proposer: Date: