Tel: 091-773601 | E-mail: insure@aquabroker.ie
Personal Information
Name*
Email*
Address
Tel.No*
Occupation
Date of Birth
Experience of Owner/Skipper
Qualifications of Owner/Skipper
Vessel History
Type / Class of Vessel
Name
Builder
Year
Last surveyed by independent surveyor
Last surveyed by Marine Survey Office
Expiry date of licence
LOA
Construction
Beam
Gross registered tonnage
Flag
Current Insurance Information
Name of Current Insurer/Previous Insurer
No Claims Bonus (No. of Years)
Current Premium
Accidents / Claimsyesno
If Yes outline details
Engines & Equipment
Engines Make & Model
HP / KW
Speed
Fuel
Other Information
Area of Operation
Mooring / Berth / Laid up
Months in Commission
Exact use of vessel
Number of passengers
Crew Liability requiredyesno
No. of Crew
Purchase Price
Name of Vessel
Total Sum Insured
