• Personal Details
    • Vessel Details
    • Incident Details
    • Stolen/Damaged Items
    • Finalise Claim

    Personal Details

    Policy Number
    Claim Number

    Insured/Owner

    Full Name
    Address
    Phone Number
    Email Address
    Was someone other than the above-named in charge of the vessel at the time of the accident? YesNo
    Please give the person’s name, age, address, occupation together with qualifications and experience in handling craft.

    Vessel Details

    Name of vessel
    Type of Vessel
    Age
    Full Value (£)
    What crew was carried?
    For what purpose was the vessel used at the time of the accident?

    Incident Details

    Was the vessel stolen? YesNo

    Details of Incident - Theft

    Date and time of the incident
    Location
    When was the vessel last inspected?
    Name & address of the person who discovered the theft In the case of the outboard motor or gear stored/fitted aboard, what security precautions or anti-theft devices were fitted or used? How was entry effected? Address & telephone number of the police station to which the loss was reported together with the Crime Reference No.

    Details of Incident - Ex Theft

    Date & time of the incident
    What was the cause?
    Where did it happen?
    Was the vessel racing at the time? YesNo Please state weather conditions, wind direction, Beaufort Scale Force Explain fully how events giving rise to your claim occurred (indicate speed, depth of water etc.)

    Description of Damage

    Please describe the nature and extent of loss or damage to your vessel What is the approximate cost of repairs or reinstatement? (an estimate from a firm of repairers should be submitted as soon as possible)
    What was done to minimise the loss or damage?
    Where can the vessel be inspected?

    Salvage

    If any salvage services have been rendered, please give full details including names and addresses of those who claim to have given such service and under what circumstances If any salvage services have been rendered, please give full details including names and addresses of those who claim to have given such service and under what circumstances

    Witnesses

    Were there any witnesses? YesNo
    Please give the names and addresses of all those who witnessed the incident Those on board your vessel Independent witnesses
    Was your Dinghy - Tender involved? YesNo
    Age
    Length
    Construction
    How was she marked with the parent vessel’s name?
    Was your outboard motor involved? YesNo
    Age
    Make
    Serial Number

    Damaged/Stolen Items

    Total (£)

    Finalise Claim

    If there are any other policies in force providing cover for the property claimed for please give details Are you registered for VAT? YesNo
    Registration Number
    I/we declare that the above answers and particulars are true and complete in every respect
    Signature of Insured
    Date
    Signature of person in charge of vessel
    Date
    Add me to your mailing list Once submitted, please refer and respond to our introductory email outlining all requested documentation to progress your claim.