SEIPPEL & LIGHT
marine insurance broker S.L

C/ Benito Feijoo 2, L6
07181 Portals Nous
TEL: +34 971 10 00 70
Fax: +34 971 67 50 90
e-Mail: marine@seippel.com

Your peace of mind is our concern
DATE:
Personal Details
NAME OF INSURED:
ADDRESS OF INSURED:
EMAIL:
TELEPHONE:
NATIONALITY OF BENEFICIAL OWNER:
DATE OF BIRTH:
PROFESSION:
   
Additional Details
EXPERIENCE/QUALIFICATIONS OF OWNER:
EXPERIENCE/QUALIFICATIONS OF SKIPPER:
CURRENT INSURER:
RENEWAL DATE:
NO CLAIMS BONUS:
CLAIMS IN LAST 5 YEARS:
   
Yacht Details
NAME OF YACHT:
VALUE HULL & MACHINERY:
BUILDER, MAKE & MODEL:
CONSTRUCTION MATERIAL:
YEAR OF BUILD:
FLAG:
GROSS TONNAGE:
PRIVATE USE OR SKIPPER OR BAREBOAT CHARTER:
NUMBER AND MAKE OF ENGINES
HORSEPOWER OF EACH:
SAIL AREA ON THE WIND:
MAX DESIGN SPEED:
FUEL TYPE:
CRUISING AREA REQUIRED:
PERMANENT MOORING LOCATION:
WATERSKIERS LIABILITY:
DETAILS OF PERMANENT &/OR SEASONAL CREW:
REGATTA COVER:
VALUE OF MAST, SPARS & SAILS:
MORTGAGE:
COMMENTS: