Premium Yacht Insurance by Jack Surija :: Forms :: Form for the non-binding insurance offer

Information about insured:

Name: *

Surname: *

Street:

ZIP Code/Place:

Mobile/phone number: *

Work phone:

Fax:

E-mail: *

Boat information:

Boat type:

+ sailing boat + motor boat/yacht

Type/model: *

Year of built:

Building material:

Sail surface: *

m2

Engine type/model:

Number of engines:

Total engine(s) power: *

HP

Fuel:

+ Diesel + Gasoline

Area of navigation:

Boat in charter:

+ no + yes

Permanent skipper on board:

+ no + yes

Risk of deliberate theft in charter:

+ no + yes

Risk of lost profit in charter:

+ no + yes

Did boat have damage in the last 4 years:

+ no + yes

Date of desired start of insurance:

Select desired insurance:

+ Crew insurance against accidents

+ Boat insurance from seizure

+ Boat owner's liability insurance, amount of coverage:

+ to 500.000,- €
+ do 1.000.000,- €
+ to 1.500.000,- €
+ to 2.500.000,- €
+ to 6.000.000,- € (minimum for entry into Italy)

+ Compulsory third-party liability insurance:

+ for personal use
+ for commercial purposes (other than charter)
+ for commercial purposes (charter)

+ Hull insurance (Casco):

A-Value of boat: €
B-Value of equipment: €
C-Value of tender boat and engine: €
Total insured amount A + B + C = €

Desired amount of policy excess (deductible):

Premium Yacht Insurance accepts bonuses earned at previous insurance companies!

The amount of Your bonus achieved so far:

Form for the non-binding insurance offer

Information about insured:

Boat information:

Select desired insurance:

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