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  QUESTIONNAIRE AND PROPOSAL FORM
 
Download Questionnaires And Proposal Form 
 
General Information
* Assured
* Address(tel/fax):
* Property Interest
Number of disposed vessels and experience in their operation (experience of head managers)
ShipOwner
Address(tel/fax)
Operator
Address(tel/fax)
Number of chartered/operated vessels.Experience
Information of the Vessel
* Name of the vessel
* Type of the vessel
Flag
Year/Place of Constructions
Register
Classification
Date of Obtaining Classification Date SelectorClear
Trading Area
Home Port
Place of Maintainence
Date of last Survey Date Selector Clear
Register Document Terms
Gross Tonnage
DeadWeight
Main Dimensions
LxBxHx
Main Engine Informations
Date of the last confirmation Date Selector Clear
Date of the last temporary repairs Date Selector Clear
Date of the last thorough repairs Date SelectorClear
Type of Cargoes Carried
Crew(Number/Nationality)
ISM Certification(place and Date)
Insured Value
Have you acting H&M coverage (yes- Insurer/no) Yes No
Have you acting P&I coverage (yes- Insurer/no) Yes No
H&M Insurance Coverage for Collision
P&I Insurance Coverage for Collision
 
Hull and Machinery insurance (H&M)
* Risks covered
Total Loss and Damage:
* Total loss, salvage and sue and labour
General average;
War Risks
Other Risks
Collision liability at the proportion (check out the necessary) 1/4 3/44/4
Date of Commencement of Insurance Date SelectorClear
Insurance Period
Liability insurance(P & I)
Scope of Cover Limit of Cover Required Deductible,USD
Liability to persons other than seamen
Crew Liability
Stowaways and Refugees
Collision with other ships
Loss or damage to fixed and floating objects
Pollution risks
Liability arising out of towage contract
Wreck Removal
Cargo Liabilities
General average and salvage contribution
Property on the insured ship
Fines
Sue and labour and legal costs
Date of Commencement of Insurance Date SelectorClear
Insurance Period
APPENDIX*
1. Claims Statistic for last 5 years.
2. Condition Survey Report (for Vessels older than 15 years)
3. Crew Labour Contract to be presented in case you need Crew Cover.
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