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Boat Insurance
Yacht owners information
Help
Do you need help filling in the form?
Contact us by chat, phone or E-Mail and we can help you filling in the form or do it for you.
Old Vessel Name
New Vessel Name
Old ICP Number
Person
Individual
Company
Company Name
Company registration nr.
First Name or Company Name
First Name
Last Name
Sex
Male
Female
Address
Post code
Town
Country
Select
Email:
Phone:
Mobile
Date of birth
Day
01
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29
30
31
Month
01
02
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12
Year
1903
1904
1905
1906
1907
1908
1909
1910
1911
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1914
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1925
1926
1927
1928
1929
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1931
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2004
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2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Place of birth
Nationality
Select
Send documentation to a different delivery address
Yes
No
Address
Post code
Town
Country
Select
Phone:
Add/Remove second owner
Owner 2
First Name
Last Name
Sex
Male
Female
Address
Post code
Town
Country
Select
Email:
Phone:
Mobile
Date of birth
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Place of birth
Nationality
Select
Starting date
Starting date
LTD details
Please enter the company name you would like to have. Beginning with the most wanted.
Possible Name 1
Possible Name 2
Possible Name 3
You can have additional shareholders.
Name Shareholder 1
Name Shareholder 2
Name Shareholder 3
Name Shareholder 4
The Boat / Yacht
Old ICP Number
Vessel Name
Type of Boat/Yacht
Select Type
Sailing Yacht
Motor sailer
Open sailing boat
Multihull sailing boat
Classic yacht
Motor Yacht
RIB and inflatable boat
Motor boat - hull only
Speedboat and sport cruiser
Open boat
Jetski
Length overall
cm
Max. beam
cm
Vertical clearance
cm incl. mast
Draft
cm
Displacement
kg
Builder
Model
Year of construction
Home port
Hull nº / HIN
Mariphone
Yes
No
Brand / Type
Engines
Engine 1
Mark and model
Serial nº
Year built
Power
HP
Installation
Inboard
Outboard
Engine 2
Mark and model
Serial nº
Year built
Power
HP
Installation
Inboard
Outboard
MMSI Details
Please supply all your equipment in the box below: (note: if you have an EPIRB we need to know the 15 character code provided by the EPIRB manufacture)
EPIRB
Gross tonnage
Beacon Manufacture
Beacon Serail Number
Beacon Type
Hex ID
Equipment 1
Equipment 2
Equipment 3
Add more equipment
The maximum amount of passengers are allowed on the boat
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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24
25
26
27
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29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
The amount of rafts
1
2
3
4
5
6
7
8
9
10
Dinghy on board
1
2
3
4
5
6
7
8
9
10
Your USA Boat Registration number
Please supply 2 emergency contact persons, they have to be different as the owner of the vessel
Contact 1
Full Name
Full Address
Email:
Phone:
Contact 2
Full Name
Full Address
Email:
Phone:
Comments
Your comments
Dealer Code
Please also send me a very competitive insurance quote
Yes
No
Click here to add a Dutch flag of 40 X 60 for 15 EUR to the order
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