Commercial Hull Form - Trident Marine Insurance

Online Quote

Looking for a quick quote? Please fill in the compulsory fields * and we will provide you with an indication. Please note the remainder of the form may be required to provide formal terms or cover.
Brokerage
Brokerage
Contact Person*
Email*
Phone*
Please provide
Cover is subject to Underwriter acceptance however may commence from the date requested and submitted.
The Insured
Insured Name*
Owner Title Owner Name D.O.B.
Are there more owners to be noted?
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Mobile
Interested Party
(Finance, Bank, Credit Union etc. if applicable)
%/$ Financed
Registered for GST?
Percentage of Business Taxable
ABN
Previous / Current Insurer
Expiry Date
The Vessel
Year*
Length*
Construction*
Make & Model*
Type
Vessel Name
Reg. / Sail No.
H.I.N.
(Hull Id Number)
No. Of Hulls
Tonnage
Description of Build
Please provide details of modifications to the Vessel
The Motor
No. Of
Year*
HP*
Make & Model
Type*
Fuel*
Serial Number (1)
Serial Number (2)
Maximum Capable Speed*
Comment
Has the motor(s) been modified in any way?
Comment
Does the motor(s) meet the hull manufacturer's recommendations?
Comment
The Trailer
Year Reg. Make & Model
Equipment & Accessories
Item Value
Sailing Vessel Only (Yachts / Catamarans)
Material/Type
Mast
Rigging
Sails
Type
Age
Mast Rigging Sails
Last Inspected
Mast Rigging Sails
Comment
Mast Rigging Sails
Vessel Storage / Area of Operation
Method of Storage*
Post Code*
Location: (Marina / Address)*
Area of operation / Cruising Itinerary*
Additional Comments
Vessel Use
Please describe fully the use of the vessel*
Survey Class*
Please provide a copy of commercial registration certificates.
Registered Passenger Capacity*
Average Passenger Per Trip
Annual Passenger Numbers
Food Served
Alcohol Served
Will the vessel be used for private purposes?
Additional Comments
Owner's & Master's experience
Date this vessel was purchased
Master of this vessel since
Please provide details of previously owned vessels. Leave blank if none.
Master Name Make & Model Hull Length Type (Power or Sail) Length of Ownership Area of Navigation
Please provide details of relevant licences and qualifications.
Master Name Marine Licences / Qualifications Date Obtained
Will others be permitted to operate vessel?
Number / details of crew
Claims & Convictions
Have you, the Proposer(s), or Drivers(s) in the past 5 years:
Had any insurances cancelled, refused or had special conditions imposed?
If yes, please provide details
Made any boat insurance claims?
Date of Loss Description of Loss Settlement Amount
Been charged or convicted with any offence?
If yes, please provide details
Is there any other information you wish to tell us or think we should know?
If yes, please provide details
General
Has your boat been surveyed?
If yes, please provide a copy
Is the vessel, or will it be under construction or undergoing a major refit?
If yes, please provide details
Options
THIRD PARTY LEGAL LIABILITY: The quote we will provide is for comprehensive insurance including Third Party Liability of $10,000,000
Do you require a different level of liability cover?
Number
PASSENGER LIABILITY: Do you require cover for passenger liability?
Reg Pax:
POLLUTION LIABILITY: Do you require cover for passenger liability?
Sum Insured
Purchase price
Purchase Date
If the total amount paid for everything is different from the agreed value nominated, please explain why.
Split up of Sum Insured
Hull & Fittings
Motor 1
Motor 2
Trailer
Equipment & Accessories (as listed above)
Masts, Spars, Rigging, Sails
$0.00
TOTAL SUM INSURED*
including hull, motor, trailer, equipment & accessories
Additional Comments / Information:
Would you like Trident Marine Insurance to obtain a quote from a selection of P&I Clubs for liability limits in the vicinity of USD 500,000,000?
Comments
This field is for validation purposes and should be left unchanged.