Please fill in the following form and submit to us, our professional Technical Representative will contact you within 24 hours.

Please note that until you receive confirmation from our Technical Representative, you will not be insured.

Contact Details
First Name:	Mr. Ms. Mrs.
Last Name:
HKID or Passport:
Email:
Contact No:
Mobile No:
Fax No:
Contact Address:
Vessel Details
Name of Vessel:
Type of Vessel:
Make & Model of Vessel:
Vessel Length:	(mtrs/ft)
Beam:	(mtrs/ft)
Hull Material:
Year of Manufacture:
Date of last Survey:
Type of Engine:	Inboard   Outboard
Number of Engines:	1   2   3   4
Make & Model of Engines:
Are any of the engines turbo charged?   --- Yes No
If so how many:	1   2   3   4
Total Engine Horse Power:
Type of fuel used:	Petrol   Diesel
Maximum Vessel speed:	(knots)
Does the Vessel need dinghy cover?   --- Yes No
Number of fire extinguishers on board:
Type of extinguisher:
Mooring location in Hong Kong:
How many months of the year will the Vessel be used for sailing?   --- 1 2 3 4 5 6 7 8 9 10 11 12
Do you require water skiers liability?   --- Yes No
Will the Vessel be used for racing, if yes is and extension in needed?   --- Yes No
Do you want cover for mast spars, sails and rigging whilst racing?   --- Yes No
If so, please state value:
Area of navigation:	Hong Kong waters Hong Kong and Macau waters Other:
Insurance Coverage
Type of cover required:	Comprehensive   Third Party Liability
Required coverage on hull and machinery:
Vessel purchase price & year:
Required coverage for third party liabilities:
Is the Vessel under mortgaging/financing?   --- Yes No
If "Yes", with who:
Do you qualify for any no claims discount?   --- Yes No
If you have answered "Yes", please state how much and insurer:
Will the Vessel be chartered?   --- Yes No
If chartered will it be?	Skippered   Unskippered
Maximum number of people allowed onboard:
Previous Insurer:
Proposers Information
Number of years experience as a skipper:
Do you ever sail alone?   --- Yes No
Have you claimed on marine insurance before?   --- Yes No
Have you been declined insurance?   --- Yes No
If you have answered "Yes" to any of the above two questions, please state when and why:
Declaration
I/We warrant that the above statements are true in every respect and no material facts have been withheld or suppressed. I/We further warrant that if such statements and particulars given in writing have been completed by persons other than the proposer he/she shall be deemed to have been the agent for the purpose of filling in the proposal. I/We agree that this declaration shall from the basis or the contract between me/us and the Insurance Company.
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