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PROPOSAL FOR "HULL" INSURANCE

PLEASE NOTE: An agent who completes a Proposal Form does so as an agent of the proposer.

(a)	What trade is vessel engaged upon and nature of cargo carried?


(b)	Is vessel ever towed or used as a tug ? If so, also answer questions 17,18,19.*

Master, Officer and Crew
Give Details of Nationality and Maritime Experience

What are the Trading / Voyage Limits?

Give full details of current/last insurances:

(a) Insured Value

(b) Insurance Conditions

(d) Statistics of Premiums and claim over the past five years shown seperately. Show any outstanding Claims seperately

Year	Premium	Claims	Outstanding
20
20
20
20
20
TOTAL

(e) Show in brief , details of any major losses

What insurance cover is required?

State period of insurance required

From to

For what amount do you wish to insure?

(a) Hull and Equipment or Machinery

(b) Machinery and Boilers

Interest	Value (N)

THE VESSEL

(a) Name of Vessels
(b) Where built, when, by whom
(c) Where Registered
(d) Registered Number
(e) Tonnage i) gross
ii)net
(f) Number in Lloyd's Register Book or any other register if registered.

State type of Vessel (i.e Steamer,Tug, Motor Launch, Trawler e.t.c)

10.

What is the construction i.e Wood (State kind of wood),steel,iron, e.t.c

11.

What navigational aids are fitted?

12.

Dimensions	(a) Length
	(b) Beam
	(c) Draught Loaded
	(d) Moulded Depth

13.

State type of engine(s), M.P. and fuel used (what is maximum designed speed of vessel

14.

Has the vessel recently been overhauled, or any major repairs undertaken? If so, Please give details

15.

When was vessel last surveyed, by whom and where? Please supply copy of the last survey report

16.

How often are surveys conducted?

17.

If your vessels is towed give details of the tugs normally used, whether the tugs are used for any purpose other than towage. Also experience and nationality of owners and Crew

18.

What is the maximum number of Vessels towed at any one time, (any one tug)?

19.

Is there any local or governmental authority which supervises towage? Is any special license required

Please note that details of all items to be insured and their respective sums should be sent by fax or mail to our Corporate Office for further processing.

I agree with all the terms and conditions. click here to read terms and conditions.

It is essential that every question with * be answered fully for proper processing of the form.

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