Yacht Proposal Form

This Proposal Form is an important document. The questions asked are material to the assessment of the insurance risk for which you are proposing. It is essential that you answer all the questions as completely and as properly as you can. Completion by you of this Proposal Form does not bind the Insurers to give a quotation or to accept any Proposal in respect of your vessel.

Any indication of premium given by Admiral is given in good faith but there will be no Insurance Contract between you and the Insurers until we have notified you that your proposal form has been accepted and we have advised you of the premium required for insuring your vessel and you have accepted that quotation.

Important Disclosure

You are reminded of the need to disclose all material information. This is information that might influence the Insurer in their decision whether to insure you, what level of premium to charge you, or what conditions to apply to your policy. If you are in any doubt please contact us for guidance. Failure to disclose all material information or misrepresentation could result in your insurance being declared void by the Insurer from inception and a claim being rejected.

N.B. Questions marked with an asterisk ('*') are mandatory

A: Particulars of Proposer

* Full Name

* Address (permanent residence)

* OR Name & Address (if company owned)

Contact Information:

* Home telephone No.

* Business telephone No.

* Mobile No.

* Fax No.

* E-mail address (land)

*E-mail address (boat/other)

* Preferred method of contact

Home telephone
Business telephone
Mobile telephone
Fax
E-mail with PDF attachments
E-mail with plain text

* Date of birth (dd/mm/yyyy)

* Nationality of proposer/beneficial owner

Usual occupation

Occupation

You must state the precise nature of the business and managing director, self employed, businessman, sales is not sufficient. If you have more than one occupation state each one.

Sailing clubs (if any)

*Are you the sole owner of the boat?

Yes No

Co-owner details:

Name: E-mail:

Ownership

The policy between each owner shall be joint and not composite. If more than one person owns the vessel, one person alone may complete the proposal form, but each co-owner must complete a separate supplementary proposal form. By completing the supplementary form each co-owner confirms the information provided in the Proposal Form relating to the vessel. Details of sailing experience must be provided for all persons who will use or be in charge of the vessel and should include the number of years, boating experience, types and sizes of boats owned or chartered, and any full details of qualifications held.

*Is your boat subject to a marine mortage?

Yes No

Please state full name of the bank/mortgage to be noted on the policy

*Do you employ a professional skipper?

Yes No

Please provide a resume to include name, age, nationality, qualifications and any accidents or losses sustained in the last five years whilst in charge of a vessel

In respect of you, and any person who will be in charge of the boat, please advise the following:

Name, age and the number of years general experience with sailing/motor boats

Number of years experience skippering boats of a similar size and type to the boat to be insured:

Type of boats owned previously

Boating qualifications

Please advise the name of your existing or previous Yacht Insurer, if any:

*Have you or any other person who will be in charge of the boat, had any accidents or losses in the last five years in connection with any vessel you or they have owned or handled?

Yes No

Date of loss (dd/mm/yyyy)	Person in charge	Circumstances of loss	Type of damage and cost of repair

*Do you have a current no claims bonus?

Yes No

No claims discount %

Number of years claim free:

*Have you, or any person who will be in charge of the boat ever had any insurance for any vessel declined, cancelled or renewed only on increased terms?

Yes No

Please give full particulars, including the name of the Insurer

*Have you, or any other person who will be in charge of the boat ever been charged with or convicted of any offence of dishonesty or any other offence which might affect the assessment of the risk?

Offences and convictions

For example offences involving drugs, drunkenness, criminal damage to property and serious driving boffences and serious injury to the person, fraud, theft and arson. This list is not intended to include all relevant offences. If you are in doubt about a particular offence you should disclose it.

Yes No

Please give full details of the offence and the sentence imposed

*Have you or any other person who will be in charge of the boat ever been declared bankrupt??

Yes No

Please give full details

B: Particulars of Boat

C: Particulars of Main Engines

D: Details of intended use

E: Items to be insured

	Item	Value
1	*The Boat
	a Hull, machinery, equipment, etc. (vessel as defined in the policy wording) - N.B. value must be greater than 0. Agreed value/market value Your policy will be issued on an agreed value basis. This means that in the event of a total or constructive total loss of the vessel by an insured peril the Underwriters will pay that agreed value. Prior to agreeing the value Underwriters will take account of the price paid and any professional valuation undertaken. You SHOULD NOT insure for the replacement cost as new. Dinghies, tenders, liferafts and outboard motors should be insured for their market value. This is particularly important with regard to dinghies and outboards as the policy does allow for a reasonable deduction to be made for the replacement or repair of outboard motors and boats to take into account any betterment or increase in value. If you are unsure as to the market value of an outboard motor then please contact us for assistance.
2	Items to be specified
	a Tender(s) - state year of manufacture, make and description


	b Outboard motor(s) - state year of manufacture, make and horse power


	c Liferaft(s) - state year of manufacture, make and capacity (i.e. 6 man)


3	Personal property Personal property Cover for personal property under this insurance is limited as cover applies only whilst the items are on board, being used in connection with the vessel or in transit between the your residence and the vessel. Items such as jewellery, mobile phones, fishing and sporting equipment, diving gear, cash and credit cards etc. are specifically excluded. Wider cover may be available under a household policy. Items valued in excess of 500 pounds sterling or currency equivalent must be specified on the policy and a description and separate value must be provided. Cover for the personal property of guests and/or crew is not provided.
	a Unspecified personal effects and property (excluding those listed below)
	b Specified items valued in excess of £500 or currency equivalent






Total sum to be insured This figure is calculated automatically. Please check and ensure that the total equates to the individual values indicated for all items to be insured. Failure to complete this section of the proposal form will delay the issue of a quotation and/or your insurance policy.	*Total sum to be insured:

F: Cruising Area and Mooring

Mooring

It is important that you advise details of all moorings used. If you change mooring during the currency of the policy you must tell us. The mooring must be adequate for the size and type of your boat and you promise to always leave the boat in a safe place when not underway.

1	Please detail as completely as possible the cruising area you require for the first 12 month insurance period Cruising area Take care to read the cruising area offered on your quotation schedule.* Changes to cruising area may affect the premium and terms offered and it is important that you contact us if you change your plans. If different cruising options have been offered please ensure you complete the proposal form to show clearly the cruising you require.

	Please detail the cruising area required for the first insurance year
2	Please advise the location of "Home Port" mooring (when afloat) Mooring It is important that you advise details of all moorings used.* If you change mooring during the currency of the policy you must tell us. The mooring must be adequate for the size and type of your boat and you promise to always leave the boat in a safe place when not underway.

3	Indicate category of mooring	Marina Pontoon berth Fore/aft to buoys or piles Swinging Will the ground tackle and risers be examined and serviced annually by a competent person or authority? Yes No
4	Will the vessel be laid up ashore at some stage during the year?
		Yes No
	Advise location where the vessel will normally be laid up and for what period it will be laid up

G: Period of Insurance

*When do you require cover to commence?

(dd/mm/yyyy)

H: Declaration and Data Protection Information

Declaration

Declaration and signature

Please read the declaration carefully prior to signing the form. The person proposing for insurance must sign the proposal form. If the proposer is a company a Director or the Secretary of that Company must sign the proposal form. If the proposer is not the owner of the vessel he/she must state what interest he/she has in the vessel and in what capacity he/she signs this form. By completing a supplementary proposal form, any co-owner confirms the information provided in respect of the vessel.

Data Protection

To enable us to provide a fast and efficient service to our customers Admiral Marine operate a centralised and secure database of all information relating to your Policy, including information provided to us on this Proposal Form.

We will share this information with other insurers through various databases to help us check the information provided and prevent fraudulent claims. Also, we will share this information where we are legally required to do so with the appropriate authorities.

If you have any objection to us holding your information, either in full or in part, you should advise us in writing immediately.

Under the terms of the Data Protection Act, we are only able to discuss details of an insurance policy with and accept any instructions from the policyholder(s). If you would like someone else to discuss your policy with us or for us to accept instructions from someone else on your behalf, please complete the details below. This applies to partners, secretaries, managers, skippers and agents. Please give the names of the people, if any, who you would like to discuss and give instructions for your insurance policy with Admiral Marine Limited. Please also advise their relationship or position with you, e.g. wife, skipper, etc.

Name	Relationship

Notes

The notes that appear on this form refer to some of the important terms of cover under your policy and are designed to assist you in completing the form. They are not intended to be exhaustive and if you are in doubt you should examine the policy wording or contact us for advice.

By submitting this form you confirm that you have read and understood the notes.

THE SUBMISSION BY YOU OF THIS PROPOSAL FORM DOES NOT BIND THE INSURERS TO GIVE A QUOTATION OR TO ACCEPT A PROPOSAL FORM IN RESPECT OF THE VESSEL NOR BIND YOU TO COMPLETE THE INSURANCE. A SUPPLEMENTARY FORM MUST BE COMPLETED BY CO-OWNERS. PLEASE INDICATE THE CAPACITY IN WHICH YOU SUBMIT THIS FORM.

Capacity in which I submit this form: