Boat Owner *

Your Email *

Telephone *

GetMyBoat Member? *
YesNo

Address/City/State/Postcode (please make sure to include city/state)*

Country *

Specify Flag/Registry *

Currency *
EuroDollarBritish Pound

Years w/o Claims *

Make/Model *

Type *
MotorSail

Boat Name *

Year Vessel Built *

Year Vessel Purchased *

Purchase Price *

Previous Boats Owned *

Skipper Name/Date of Birth*

Boating Experience: Years/Type of Vessels/Navigation Areas *

Specify Mariner Qualifications *

Safety/Security Equipment
Auto Fire ExtFume DetectorRadarGPSDepth FinderAuto PilotHand Held Fire ExtEngine AlarmVHF RadioTheft AlarmTracking DeviceSurveillance SystemLocked/fenced enclosureSecured BuildingYacht Controller

Hull Machinery & Equipment: Insured Value

Road Trailer: Insured Value

Dinghy/Tender: Insured Value

Outboard Motor: Insured Value

Life Raft: Insured Value

Personal Effects: Insured Value

Total Sum Insured

Liability Limit - 3m Max
500,0001,000,0002,000,0003,000,000

Waterski Liability
YesNo

Passenger Liability
YesNo

Crew Liability
YesNo
If yes, Number of crew

Boat Details - Length/Beam *

Maximum Speed - Knots *

Type of Construction *
---AluminiumGRPGRP - hypalonWoodSteelOther

Engine Manufacturer/Year *

Engine HP *

Fuel *
GasDiesel

Type of Mooring *
---SwingFore and AftChainPileMarina pontoonDry StackDry Stack - berthing

Mooring Country *

Marina *

Marina Address/City/State *

Cruising Areas - Please pick one

UK/Ireland/Inland Europe?
---UKIrelandChannel IslandsEnglish ChannelEurope Inland

Mediterranean?
---Med Waters not east of 10º (excl. territorial waters of Algeria)Med Waters not east of 20º (excl. territorial waters of Algeria & Libya)Med Waters not east of 30º (excl. territorial waters of Algeria, Libya and Egypt)Mediterranean Sea (excl. territorial waters of Algeria, Libya, Egypt, Syria, Lebanon and Israel)

USA/Canada?
---East Coast U.SFloridaCaribbeanGulf CoastPacificInland - Great LakesInland - RiversInland - Others

Other Cruising Areas

Usage Details *
Skippered CharterBareboat Charter

Number of Charter Days per Year *

Maximum Number of Passengers per Trip*

Has the proposer ever had an insurer decline a proposal? *
YesNo

Has the proposer ever had an insurer not invite renewal or cancel a policy? *
YesNo

Has the proposer ever had an insurer impose premium increases (other than normal rate increases) or special policy conditions? *
YesNo

Has the proposer ever been convicted or charged with a criminal offence? *
YesNo

Has the proposer ever been declared bankrupt or insolvent? *
YesNo

Effective Date of Cover * (YYYY-MM-DD)

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