Maritime Insurance Application
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This form may be filled in for a no obligation quote for marine insurance.
If you are looking for a quote on a Commercial fishing vessel, the correct form is here

We will make no part of this information public.
We will not sell, lend or reproduce it in any way to unauthorised persons. We will make a proportion of this information known to Maritime Underwriters.

The insurance quoted can be payable in quarterly instalments,
an advantage over yearly payments for those who prefer it.

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Name of Vessel 
     

Owner assured Information.

Name
Address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Phone
FAX
E-mail

Mortgagee Information 1st

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Mortgagee Information 2nd

Name
Address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Vessel Information

Year Built             
Const.      

GRT         
Length      
Beam        
Draft       
Home Port  
State/USCG Reg#  
Last Survey date    
Trading Area      
Cargo Details            
Purchase Price US    
Present Market Value

Replacement Cost      
Navigation Limits     

Insurance Requested

Current Carrier          
Expiration Date of Policy  or commencement of this one.
 

Hull  D/A             Bow      W/R  

P&I  D/A Crew        O/P   

Current premium

Hull       P&I  

 

Loss Experience - Hull P&I - Past Five (5) Years

        Date 1

Description 

                      Amount Paid  

         Date 2 

Description  

                      Amount Paid  

I want a quote and undertake that this is an honest representation of the facts.

Yes No


When you press submit, you may have to wait up to 3 minutes for the form to process

If we need any further information, we will get back to you.

Thank you

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Copyright Armata for Ships for Sale
Last revised: February 26, 2011

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E-mail : info@ships-for-sale.com
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All the details on these pages are given in good faith and are believed to be accurate, but no warranty
of the veracity of any offer is either stated nor implied.

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Revised: August 15, 2017

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