Third Party Only - 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
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
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 ski manufacturer's recommendations?
Comment
The Trailer
Year
Reg.
Make & Model
Sailing Vessel Only (Yachts / Catamarans)
Material/Type
Mast
Rigging
Sails
Vessel Storage
Method of Storage*
Post Code*
Location: (Marina / Address)*
Area of operation / Cruising Itinerary*
Additional Comments
Vessel Use
What will the vessel be used for?
Private Use
Timeshare Arrangement
Charter / Hire
Demonstration
Corporate Functions
Commercial Workboat
Other
Other. Please provide details:
Additional Comments
Owner's & Skipper's experience
Date this vessel was purchased
Please provide details of previously owned vessels. Leave blank if none.
Skipper Name Make & Model Hull Length Type (Power or Sail) Length of Ownership Area of Navigation
Please provide details of relevant licences and qualifications.
Skipper Name Marine Licences / Qualifications Date Obtained
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 Third Party Liability of $10,000,000. Do you require a different level of liability cover?
Additional Comments / Information:
Email
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