Assured:
Address of assured:
Owners :
Managers :
Proposed date of attachment:
Full description of the Assured's operations and marine experience
(Please attach, if possible, a company profile / CV's).
:
Vessel Details
Name :
Ex-Name :
Type :
Built :
GT :
Flag :
Class :
Last SS/DD :
Hull Value :
Trading
:
Cargo Details :
Type of cargoes :
Crew Details
Number of crew each vessel :
Number of Officers each vessel :
Number of Ratings each vessel :
Nationalities :
Hull & Machinery Loss Record for the last 5 years :
P&I Loss Record for the last 5 years :
Details of major claims mentioned above :
Current
Hull & Machinery policy
Where is the Hull & Machinery cover currently placed ?
What are the current H+M Conditions ?
What is the current H+M Deductible ?
C
urrent P&I cover
Where is the current P&I cover placed ?
What is the current P&I Limit of Liability ?
What are the current P&I Deductibles for :
cargo claims
crew claims
collision claims
all other claims
Signed by :
Date :
