ISLAND PAGE
ABOUT US
CONTACT US
 
 
IBA Insurance Proposal Form
 
ASSURED
NAME :
ADDRESS :
TELEPHONE :
   
VESSEL
NAME :
FLAG :
REGISTRATION :
TYPE :
BUILDERS :
YEAR BUILD :
H.MATERIAL :
MAX. SPEED :
L.O.A :
BEAM :
DRAFT :
USE :
ENGINES
INBOARD
OUTBOARD
 IN/OUTBOARD
BUILDERS :
HP :
YEAR :
FUEL :
 
CLAIMS OF THE LAST 5 YEARS :
IS THERE ANY OUTSTANDING MORTGAGEES ?
THIRD PARTY LIABILITY
Limit E 540.000, as per L. 2743/99 :
X2 times :
INSURED VALUES
HULL :
MAIN ENGINE(S):
SUPPLEMENTARY EQUIPMENT :
TOTAL INS. VALUE :
LIST OF SUPPLEMENTARY EQUIPMENT
Item :
Value :
Item :
Value :
Item :
Value :
Item :
Value :
MOORINGS
PERIOD : (MONTH) from :
to :
PLACE :
LAID UP
PERIOD : (MONTH) from :
to :
PLACE :
Liabilities from water skiers :
Road transit :
Coverage of O/B motor :
Racing Risks :
if yes, the replacement values (mast, spars, sails, sails) are
CRUISING LIMITS :
INSURANCE PERIOD :
PREMIUM - MODE OF PAYMENT
2 installment
I declare to the best of my knowledge and belief, that all the information provided in connection with this Proposal, whether in my own hands or not, is true and i have not concealed or faisified any material fact.
Please type your e-mail address :
 
 
Ionian Boat Assistance Copyright 2007 all rights reserved