To prepare the most accurate and competitive marine insurance quote, we need to collect some information on the vessel, the owner, and crew, and use of the vessel. Please assist us in completing this form. If you have any questions either contact us or leave field blank and we will contact you.

When you have completed the form, please click on the submit button and we can start preparing the quote for you

Note: Please read QBE Aqua Cover proposal notes before completing this application. The proposal notes contain important information regarding coverage

Section 1 _ Proposer information

Applicant name                      if boat is owned by company, please insert company name

Applicant street address          if company, insert company registered address

City, state, country, ZIP      

Day time telephone          Fax:           Skype: 

Email:                                  

Nationality                                   Date of birth (or company formed) 

Have you, or any other person who will take charge of the vessel, or any other person with a financial interest in the vessel;

          Ever had insurance refused or cancelled?     Yes  No  If yes, please detail

          Suffered any accidents or losses in 5 years? Yes  No If yes, please detail

          Charged or convicted of any offenses in last 5 years? Yes No If yes, please detail

Section 2   Vessel information

Vessel name                           Year of construction          Power Sail    Number of engines  

Registration country                     Engine make/ model 

Registration number                     Engine serial no(s)   

Purchase date                            Engine: Inboard Outboard Jet Sterndrive

Purchase price                           Other engine type?      

Last survey date                          Turbo?  Yes No      Engine power (HP)

Make / model                               Cruising speed knots                Top speed knots

Construction material   Please select GRP Steel Aluminium Wood Carbon fibre Concrete Other                                       Fuel: Capacity litres.     Type Gasoline Diesel

Stabilizers fitted?      Yes No                                      Length m      Beam m       Draft m

Sails and Rigging  (if power boat, please skip)

Type of rig: Please select NA Sloop Ketch Yawl Schooner Brigantine Other   If other,specify          Number of spreaders 0 1 2 3 4 5

Mast: Material Please select Aluminium Steel Wood Carbon fibre Other   Mast type  Please select Masthead Fractional Other                Sails carried on board

Is vessel fitted with centreboard or lifting keel?  Yes No

Equipment

Is vessel fitted with?:

VHF   Depth sounder   SSB   Immarsat   Autopilot   Compass   GPS   Radar reflector   EPIRB    First aid kit

Lifejackets quantity:           Safety harness quantity:           Lifebuoy quantity           Smoke/ heat detector quantity   

                              Flares                                                            Liferaft                                                   Fire extinguishers                            

Type                            Qty         Expiry date               Make / model   Capacity   Expiry                  Qty      Auto/ manual     Expiry  

Please select Handflare Rocket parachute Orange smoke                                  Manual Automatic     

Please select Handflare Rocket parachaute Orange smoke                                                                                       Manual Automatic    

Tender details         Outboard details

Any other special equipment:

Experience / qualifications

Coastal Operations (within 100 nautical miles of Thai coast)

Skipper Name                           Age     Years Experience           Qualifications

Intended area of coastal operation

Vessel will be primarily berthed at:   Please select Yacht Haven Marina Boat Lagoon Marina Royal Phuket marina Ocean marina Lakeside marina Royal Langkawi YC Rebak marina Telaga Harbour marina Other marina Fixed mooring At anchor     If at anchor or mooring, please specify location

Off shore operations (Outside Thailand and/or more than 100 nautical miles of Thai coast

Name                                    Crew position         Age     Years Experience               Qualifications

List previous offshore passages by:

Skipper:

Vessel: 

Intended voyages:

Navigation area                Times/ year   Max days per voyage       Mooring at destination

Racing (please skip if no racing intended)

If club racing, name of club:

Race/ regatta                                Location                    Proposed dates                     Max distance any one leg (nm)

Previous race history by:

Skipper:

Vessel: 

Commercial use (skip if no commercial use intended)

Use: Bareboat charter   Crewed charter   Day excursions   Other (specify):

Crew: Skipper    Engineer Cook Other crew (number)   Dive instructor   Sail instructor Certified medic/ first aid

Detail any other crew:               Do you supply food and drink?: Yes   No

Any voyage:     Max number of passengers             Max number of charter days 

Lay Up (skip if no lay up)

If vessel is laid up for part of the year, we will continue to provide insurance cover against fire, theft, and accidental damage and a premium discount will be allowed in view of the reduced cover

Lay up location:    Lay up location is: Marina   Fixed mooring   At anchor

Lay up months:  Jan    Feb    Mar    Apr    May    Jun    Jul    Aug    Sep    Oct    Nov    Dec

Insurance cover

Additional coverage for: Inland Transit (trailer) Water skier liability Food/ Drink Compulsory passenger cover (commercial only)

Currency: US Dollars Thai baht Euro  

                    Sum to be Insured                                                        Sum to be insured

Vessel                                       Third party liability   

Note vessel sum insured should be based upon full replacement value. Sums insured less than this will be subject to 'average clause' in event of partial loss

Sub limits :                                                               Death and disability   per person

Hull                                           Death and disability   per policy period         

Engines                                      Personal effects      

Mast, rig, sails

Equipment      

Tender O/B                

Many thanks for taking the time to complete this application. Please review and if you are happy with the information, then please  and we will start work on your quotation.

If you like to re-start then please