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Boat Insurance Proposal
A. Personal Information
 Title  Name *  Surname *   ID Card Number *  E-Mail Address *
Postal Address *  Town Tel No. - Home * Mobile Office *
Occupation *   
 

 

B. Particulars of Vessel
Name of Vessel  Reg No Type/Class of Model
Overall Length Hull material Year of Build
Was the vessel Professionally built or amateur built
Builder's Name  
 
If amateur built or 15 years old or over, a Full Condition Survey report will be required.
Conversions and vessels over 25 years old are not acceptable.
Date of purchase Purchase price (€)
  Make Year of Manufacture HP Serial No.
Outboard 1
Outboard 2
Inboard 1
Inboard 2
What is the maximum speed of the vessel with these engines ?
Has the vessel ever been damaged ? YES NO
If YES please give details
Is vessel fitted with remote control or automatic fire extinguishers in engine area or gallery? YES NO
If YES state make
What other type of fire extinguishers are carried ?
  
C. Sums to be insured
Hull and Equipment indicating all items normally given in the vessel specifications should it be offered for sale.
Special equipment Items of electronic that do not form part of the internal fitting which may be purchased separatly and removed from the vessel when not in use.


Please list all items over €600 included in total value.
Description Value (€)
Tender/dinghy (the vessel's name must be shown on the tender to comply with policy conditions).
Outboard motor(s)
Road trailer / trolley
Personal effects Items of clothing or equipment of a nautical nature which are kept or used on boardthe vessel whilst in use, but nwould not normally be sold with the main vessel.
Please list all items over €250 included in total value.
Description Value (€)
Total Sum Insured
 
D. Additional risks
Do you wish to receive a discount from the premium for increasing the standard policy excess?      YES NO
If YES state amount you are willing to take.


Do you wish to cover the mast spars, sails & rigging against racing risks? If so please indicate the estimated cost of replacing them "as new".
Do you wish to extend cover to include legal liability to and of water skiers being towed by your vessel?     YES NO
 
E. Additional risks
(This option is applicable is only for cabin cruisers)
   
Do you wish to increase the limit in respect of loss of damage to the rudder, propellor, shaft, motor, electrical machinery or battery and their connections from €2,500 to €6,000 at an additional premium? YES NO


What crew will be carried ? (state experience & qualifications)
Where will the vessel be generally moored when in commission?
State dates between which it will be out of commission. (laid up). From To 
Where will it be laid up? At Ashore  Afloat
 
 
F. Cruising range
Maltese territorial waters. YES NO Others


 
G. General questions
1. How many years experience have you as an owner/crew, including types of vessels

2. Do you have any sailing qualifications? (proof will be required)

 YES NO


3. Are you the sole owner of the vessel? YES NO
Give details of any co-owners or interested parties.
4. To the best of your knowledge & belief have you or any person you will permit to use the vessel :
a. suffered any accident or loss in the last 5 years with any vessel used or owned? YES NO
b. had any insurance or any vessel cancelled or refused or had any special terms imposed? YES NO
c. ever been convicted of any offence involving dishonesty, fraud, violence, criminal damage, arson,
drugs or is any prosecution pending?		 YES NO
d. are you entitled to no claim bonus? YES NO
If the answer to any of these questions is YES please provide full details
 
 
Declaration Very Important

When completing the application, you should disclose any facts which may influence the assessment & acceptance of this insurance. If you are in any doubt as to whether certain facts are relevant, please ask your insurance broker or GasanMamo Insurance office. Failure to disclose all relevant facts may invalidate your policy or may result in the policy not operating fully.

I/we have read, or have had read over to me/us, the contents of this completed proposal and I/we declare that the information given in it is, to the best of my/our knowledge and belief, correct and complete.

You should keep a written record (including copies of letters) of any information you give to us or to your broker or agent when entering into this contract of insurance.

Please specify if you want to receive updates on promotions, or any third party offers Yes No

You may forward this Proposal Form to us by clicking "Submit Form". Please remember that cover will only commence once we have confirmed it to you in writing.

 

 

Data Protection Notice

To the extent that the information supplied by you, whether orally or in writing, constitutes personal data, including sensitive data within the provisions of the Data Protection Act, you consent to the processing of such data for purposes of administering your proposal for insurance, your Policy, underwriting, handling of claims and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. We maybe required to collect further information from our sub-agents, other insurance companies, insurance intermediaries or insurance associations.

In addition, we may pass some or all of the information to other insurance companies, or insurance associations for underwriting and claims handling purposes and also for the purposes of detecting, preventing and suppressing fraud and of keeping statistics. This also helps us to check the information provided. When we deal with your request for insurance, we may search this information. When you tell us about an incident which may or may not give rise to a claim, we will pass information relating to it to the Malta Insurance Association.

You have the right to request access to, and rectification of, your personal data held by us by directing your request in writing signed by yourself to the Data Protection Officer, GasanMamo Insurance Ltd, Msida Road, Gzira GZR 1405
 

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GasanMamo Insurance Limited is authorised to carry on business of insurance in Malta in terms of the Insurance Business Act 1998, regulated by the Malta Financial Services Authority. Company Registration Number: C3143