APPLICATION FORM YACHT LIABILITY INSURANCE POLICY

APPLICATION FORM YACHT LIABILITY INSURANCE POLICY

APPLICATION FORM Yacht liability insurance policy 1. Contact details Please provide us with the name and contact details of the person/company to be insured. Name* Address* Postcode/Zipcode Telephone Mobile Email Country 2. Other named parties a. Names of other parties who have an interest in the operation of the yacht and are to be named on the policy. Full Name Country Nature of interest b. Country of domicile of the beneficial owner (if yacht is insured in a company name) 2 Yacht liability insurance policy - Application form

3. Yacht Details a. Please complete the following sections for all yachts that require a quotation Yacht 1 Yacht 2 Yacht 3 Builder Model Yacht name Gross tonnage Year of build Flag Port of registry Classification society* (if applicable) Certifying authority* IMO number Insured hull and machinery value Number of crew Registered passenger carrying capacity Engine horse power Make and model of engine Number of engines * If the classification society or certifying authority is not shown on the list of options, please enter details in the appropriate field. 3 Yacht liability insurance policy - Application form

b. Please complete the following sections for all separately registered tenders that require a quotation. Tender 1 Tender 2 Tender 3 Builder Model Yacht name Gross tonnage Year of build Flag Port of registry Classification society* (if applicable) Certifying authority* IMO number Insured hull and machinery value Number of crew Registered passenger carrying capacity Engine horse power Make and model of engine Number of engines * If the classification society or certifying authority is not shown on the list of options, please enter details in the appropriate field. 4 Yacht liability insurance policy - Application form

4. Area of navigation a. Navigation limits required b. Please provide details of any lay up periods during the next 12 months (we do not give lay up returns for lay up periods notified in arrears). 5. Private Mooring a. Do you have private mooring? If so, where is it? 6. Type of operations undertaken Please indicate the type of operation you wish to use your yacht for: Private pleasure only Bareboat chartering for hire or reward Fully crewed (skippered) chartering Racing - applicable to sailing yachts only (there is no cover for motor yachts when racing unless we agree otherwise) Please select the type of racing to be undertaken: Casual racing (non club or association organised) Yacht club or sailing association organised Professional and/or ocean racing (this is not covered unless we agree in advance) 7. Other operations Please indicate if you intend to: Undertake commercial diving Operate a submarine, mini sub or diving bell 5 Yacht liability insurance policy - Application form

8. Water sports cover Please indicate if you require cover for the use of water sports equipment. (This must belong to and be carried by your yacht to be eligible for insurance cover) Yes No 9. Current insurance arrangements a. Name of current protection and indemnity (P&I) insurer b. Name of current hull and machinery (H&M) insurer c. Name of current war risks insurer d. Extent of: i. Collision with other vessels (RDC) ii. Fixed and Floating Objects (FFO) iii. Removal of wreck iv. Legal Assistance and Defence cover (FD&D) Limit e. Please provide details of any other yacht liability risks covered under any other policy Type Crew Water sports Other (please specify) Limit of liability 10. Crew a. Please supply the following information in respect of your crew* Nationality Total number of crew Nationality Total number of crew *Please inform us of any further nationalities in a covering letter or email 6 Yacht liability insurance policy - Application form

b. Please provide details of any personal accident or health care policies in force for your crew or guests 11. War risks Please indicate whether or not you intend to sail within any of the current Hull, war, strikes, terrorism and related perils listed area (copy of listed areas can be obtained from our website at www.shipownersclub.com): Yes No 12. Claims history Please provide details of any incident over the last five years that has given rise to a liability claim on insurers, may yet give rise to claim, or would have given rise to a claim on insurers had P&I insurance cover been in place. Date of loss Type of loss Total value of claim Total paid claim to date Total estimated claim Policy excess 13. General Our insurance cover is provided to you on the understanding that: a. Your yacht is used for lawful activities b. There will be no activity on board which is unsafe or unduly hazardous c. You will ensure that your yacht complies with all regulations of flag state, certifying authority or classification society, SOLAS, MARPOL or other code or regulation applicable to the yacht d. You have never been refused insurance or been bankrupt e. To the best of your knowledge, there are no other material facts which you need to supply (material facts are those facts that influence whether we wish to insure you and upon what terms) Completed by Date 7 Yacht liability insurance policy - Application form