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Pleasure Craft Insurance Application Form

Please fill in all the mandatory fields marked with *

Vessel Details

Vessel Name*

Vessel Type*

Vessel Length (ft)*

Port of Registry*


Year Built*

Licence No.*

Type of Hull*

Material of Hull*

(if wood state method of construction)

Material of Mast, Rigging and Sails*





Make of Engine(s)*

Location of Engine*

No. of Engine(s)*

Total Engine Power (HP)*

Maximum Design Speed (knots)*

Fuel Used*

Place of Mooring*

Surface Drive?*

Type of Engine*

Cover Details

Type of Coverage Needed*

(A) Hull and equipment including inboard engine (if any)

Purchase Date

Purchase Price (USD)

Insured Value (USD)

(B) Outboard motor(s) to parent vessel

Purchase Date

Purchase Price (USD)

Insured Value (USD)

(C) Dinghy/tender to parent vessel N.B. (Must be permanently marked with name of parent vessel)

Purchase Date

Purchase Price (USD)

Insured Value (USD)

(D) Outboard motor(s) to dinghy/tender

Purchase Date

Purchase Price (USD)

Insured Value (USD)

(E) Personal effects

Purchase Date

(F) Special equipment

Purchase Date

Purchase Price (USD)

Insured Value (USD)

Other Coverage

Third party liability required?*

Third Party Liability Limit (USD)*

Masts, spars and sails against racing risks required?*

Total Replacement Value of those item mentioned above (USD)*

Waterskiing, aquaplaning or any similar sport required?*

Please advise type of activity (e.g. Wakeboarding, doughnuts, banana boats, waterskiing etc.)*

Limit of liability of the activities mentioned above*

Outboard motors against dropping or falling overboard required?*

Additional Information

How many years experience have you had in handling craft?*

(state if permanent, professional, or other crew will be employed)


What accidents/incidents/losses or insurance claims have happened during the past five years in connection with any vessel you have sailed or owned? (state the details if applicable)

Have you had an insurance for any vessel but declined or cancelled?*

Is the vessel used for private pleasure purposes only?*

Is the vessel used for corporate entertainment?*

Is the vessel used for paid charter?*

Is the vessel used as a houseboat?*

What cruising range is to be covered?*

Will any major alterations or major repairs take place within the next 12 months?*

Have you or any other person you have allowed or may allow to use your craft, ever been charged with or convicted of any offence involving dishonesty of any kind, e.g. arson, robbery, smuggling, theft or handling stolen goods?*

Please give details of moored security and precautions taken against the vessel being stolen.*

Details of Fire Extinguisher System


Please note that insurance company requirements for fire fighting or preventative systems vary.


You must check that your system complies with Underwriters requirements and ensure that it is fully serviced and operational at all time.

Is vessel fitted with a fixed fire fighting system in the engine room?*

Where are the manual operating controls situated?*

Does vessel have a galley?*

What fire fighting systems are installed in this area?

No. of hand held fire extinguishers on board*

Location of hand held fire extinguishers on board*

Has the vessel been surveyed by a qualified surveyor?*

If "Yes", please upload a copy*

Any other information?


All material facts must be disclosed to Underwriters whether or not the subject of a specific question above. A material fact is one which a prudent Underwriter would regard as likely to influence the acceptance or assessment of the proposal. Non-disclosure or misrepresentation of a material fact may result in the insurance being void. If you are in any doubt whether facts would be considered material, you should disclose them. Should something become known or a matter arise during the currency of your insurance which could be considered to be a material fact this should also be advised to Underwriters immediately.

I declare that the particulars and answers are correct and complete in every respect to my knowledge and belief. I agree that this proposal and declaration shall form the basis of the contract of insurance between me and the Underwriters if a policy is issued.

I further declare and agree that if the statement and particulars above have been completed in the handwriting of any other person other than the undersigned, such person is deemed to be the agent of the proposer for the completion purposes.

Details of Applicant

Full Name*

Corresponding Address

Phone Number*


Fax No.

Name of Employer (if any)

Position Held

Effective Date of Insurance (for 1 year)*

Owner's Nationality*

Finance / Mortgage Company (if any)

Successfully submitted!

Please fill in all the mandatory fields marked with *

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