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Marine Insurance Proposal Form
First name
Last name
Birthday
Day
Month
Year
Phone
Address
Email
Occupation
Employer
Name of Vessel
Year Built
Length of Vessel
Beam
Price Paid
Hull Material
A Professional Kit?
Builder's Name
Builder Qualifications
Engine 1 - Year & Make
Horsepower
Serial Number
Engine 2 - Year & Make
Horsepower
Serial Number
Engine 3 - Year & Make
Horsepower
Serial Number
Max speed of vessel with these engines
Has the vessel ever been damaged?
If YES, please provide details
Is vessel fitted with auto or remote controlled fire extinguishers in engine and tank areas?
If YES, please state make and location
If No, please provide details of other types of extinguishers carried
Submit
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