Name*

Email*

Address

Tel.No*

Occupation

Date of Birth

Experience of Owner/Skipper

Qualifications of Owner/Skipper

Type / Class of Vessel

Builder

Year

Last surveyed by independent surveyor

Last surveyed by Marine Survey Office

Expiry date of licence

LOA

Construction

Beam

Gross registered tonnage

Registration No.

Flag

Name of Current Insurer/Previous Insurer

No Claims Bonus (No. of Years)

Current Premium

Accidents / Claimsyesno

If Yes outline details

Engines Make & Model

Year

HP / KW

Speed

Fuel

Area of Operation

Mooring / Berth / Laid up

Months in Commission

Exact use of vessel / Type of fishing

Crew Liability requiredyesno

No. of Crew

Purchase Price

Purchase Date

Name of Vessel

Total Sum Insured