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Aquabroker Marine Insurance – Quote

To receive a quotation, please fill out the following form. All information will be treated as confidential.

Personal Information

Name*

Email*

Date of Birth*

Tel.No*

Occupation

Address line 1*

Address line 2

Town*

County*

Eircode*

Experience of Owner/Skipper

Qualifications of Owner/Skipper

Current Insurance Information

Name of Current Insurer/Previous Insurer

No Claims Bonus (No. of Years)

Current Premium

Have you ever had any claims or accidents with any vessels owned or operated by you?YesNo

Date of claim

Cause of claim

Damage sustained

Settlement amount

Vessel

Type / Class of Vessel*

Builder*

Model*

Year*

Hull Construction*

Length*

Material of mast

Beam*

Last Surveyed

Please Provide Copy of the last survey

8MB max. Supported formats: PDF, JPG, PNG and DOCX

Purchase Price*

Purchase Date*

Name of Vessel

Country of Registration

Engines

Engines Make & Model*

Year*

HP*

Speed*

Fuel*

Details of Mooring

Mooring Type

Mooring Location

Other Information

Cruising Area

Water SkiingYesNo

Water ToysYesNo

Road TransitYesNo

Do you race your vessel?YesNo

How many races do you anticipate you will take part in?

What kind of racing is this?

Replacement value of Mast, Sails and Rigging?

Any Additional Information

Values

Hull, Machinery & Equipment*

Outboard Motor

Trailer

Tender

Liferaft

Personal Effects

Total Sum Insured

If there is any additional information you feel may be relevant

Retention of Records

As I am currently not a client of the firm, if I choose not to proceed with a product now, I agree that the firm may keep my records for up to 12 months.

I ConsentI Do Not Consent

Aquabroker Marine Insurance – Quote

Contact Us

For Marine Insurance quotation please contact us directly

Contact Us

For Marine Insurance quotation please contact us directly