Boat Insurance – Assessment of Demands and Needs

Insurance Brokers, Companies and Intermediaries

Other Insurance Brokers, Insurance Companies or Insurance Intermediaries that you have approached for quotations to date

Are you an existing MIB Customer?*

Yes
No

Please specify your Customer Number

Policy Holder Details

Name and Surname*

ID Number

Date of Birth

Email*

Enter Email Confirm Email

Contact Phone Number*

Company Registration

Details of Flag Registry*

Hidden

Address

Address of property to be insured

Postal Address*

Street Address Address Line 2 City ZIP / Postal Code Country

Business/Occupation*

Nautical Licence*

Do you hold a nautical licence?

Yes
No

Experience*

Number of years of boating/sailing experience

Have you ever had any insurance proposal declined or cancelled?*

Yes
No

Please specify

Vessel Details

Vessel Use*

Private
Chartered
Commercial

Placeholder (ignore)

Details of commercial use

Details of charter use

Vessel Name*

Make and Model*

Age of Vessel*

Registration Number*

Type of Vessel*

Vessel Material*

Drivers

Name	Age	Actions

There are no Drivers.

Length*

Beam*

Engines

Make and Model	Type	Year of Manufacture	Actions

There are no Engines.

Tender Details

Tender Auxiliary Engine Details

Maximum Knots*

Hidden

Territorial/Cruising Waters

Territorial/Cruising Waters*

Maltese Territorial Waters
Maltese and Italian Territorial Waters
Mediterranean Waters

Type of Cover*

Comprehensive
Third Party Only

Date last Inspection/Valuation Survey was carried out

Details of who carried out last Inspection/Valuation Survey

Where is the Vessel located at present?*

Mooring when 'In Commission'*

Mooring when 'Out of Commisson'

Laid up location details/address

In Commission Period

Loss/Claim History

To the best of your knowledge and belief have you or any other person you will permit to use the vessel ever suffered any accident or loss in the last 5 years with any vessel used or owned?

Accident Details	Actions

There are no Losses.

Present Insurance Company

No Claims Discount applicable

Are you buying this vessel for the first time?*

Yes
No

Inspection/Valuation Report and Licence

Attach a copy of the latest Inspection or Valuation Survey report and Nautical Licence to assist further

Drop files here or

Max. file size: 5 MB.

Vessel Sum Insured

If requesting Comprehensive Cover

Hull and Machinery Sums Insured*

Including inboard engine/s

Outboard Machinery Sums Insured*

Personal Effects Sums Insured*

Navigation Equipment Sums Insured*

Trailer Sums Insured*

Tender Sums Insured*

Tender Outboard Engine Sums Insured*

Other Sums Insured*

Other Sums Insured Type*

Additional Details

Additional Policies

Details of any other insurance policies that you may consider transferring and placing though us

Additional Comments

Attach any relevant documents.

Drop files here or

Max. file size: 5 MB.

Terms Accept*

I have read and accept MIB's Client Terms of Business & Privacy Policy.*

I understand that by completing this form the data will be processed by MIB in line with GDPR and hereby consent that this data (including if needed sensitive data as defined in article 9 of GDPR) are used for the purposes of providing your insurance services.

I also understand that it is my responsibility to secure and hold the necessary consent from any employees, beneficiaries or other third parties direct or indirectly involved in the insurance proposal/arrangements and whose data will be processed by MIB and the providers of insurance and ancillary services.

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Boat Insurance – Assessment of Demands and Needs

Policy Holder Details

Vessel Details

Vessel Sum Insured

Additional Details

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