Proposal form

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◼︎INSURED DETAILS

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◼︎BENEFICIAL OWNER

Occupation / Industry

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◼︎YACHT INFORMATION

Type of yacht:

Motor yacht Sailing yacht

Last refit (if applicable)

Built materials

Type:

Displacement Hulls Semi Displacement Hulls Multi-Hulls

MCA / MLC compliance

Yes No

Propulsion type / method:

Maximum Designed Speed (knots)

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◼︎USE & NAVIGATION

Use of the yacht:

* Next 12 months Itinerary:

Where is the yacht moored ?:

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◼︎CREW DETAILS

No of Permanent Crew (employed over 12 months)

No of above on rotation

No of Seasonal Crew (up to 6 months)

Wage roll (combined over 12 months)

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◼︎TENDERS & TOYS

Please feel free to provide a separate list with details (make, model, year, value)

Helicopter onboard

Yes No

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◼︎INSURANCE DETAILS

Total Insured Value (EUR/USD)

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◼︎OPTIONAL COVER

Guests Personal Accident

Guests Personal Accident Guests Medical Expenses Legal Assistance

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◼︎CLAIMS HISTORY & CERTIFICATION

Have there been any accidents/claims/losses on any of your previous yachts in the last 5 years ?

Yes No

If YES please give details:

Have you ever been refused insurance ?

Yes No

If YES please give details:

Has the Captain been involved in any accidents/claims/losses on any previous yachts whilst employed as Captain in the past 5 years ?

Yes No

Declaration

All material facts must be disclosed to Underwriters whether or not the subject of a specific question above. A material fact is one which prudent Underwriters would regard as likely to influence the acceptance or assessment of the proposal.

Nondisclosure or misrepresentation of material fact may result in the insurance being void. If you are in any doubt whether facts would be considered material, you should disclose them.
I declare that the particulars and answers are correct and complete in every respect to my knowledge and belief.

I agree that this proposal and declaration shall form the basis of the contract of insurance between me and Underwriters if a policy is issued.

I further declare and agree that if the statement and particulars above have been completed in the handwriting of any other person than the undersigned, such person deemed to be the agent of the proposer for the completion purposes. By signing this document, you confirm that you have read, understand, and agree to the Standard Terms and Conditions.

We hereby give ONLYYACHT the authority to research, negotiate, obtain and bind insurance terms, quotations and premiums’ on our behalf for the details of the yacht, its crew and liability exposures.

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◼︎DOCUMENTS TO BE PROVIDED

The Owning Company’s Certificate of Incorporation

The vessel’s Certificate of Registry

The beneficial owner passport or national ID

A completed and signed copy of the Know Your Customer form

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