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Form for the non-binding insurance offer

Required boxes are marked with *

Information about insured:

Name: *
Surname: *
Street:
ZIP Code/Place:
Mobile/phone number: *
Work phone:
Fax:
E-mail: *

Boat information:

Boat type:   
Type/model: *
Year of built:
Building material:
Sail surface: * m2
Engine type/model:
Number of engines:
Total engine(s) power: * HP
Fuel:   
Area of navigation:
Boat in charter:
Permanent skipper on board:
Risk of deliberate theft in charter:
Risk of lost profit in charter:
Did boat have damage in the last 4 years:
Date of desired start of insurance:

Select desired insurance:







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:


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