Marine Public Liability Insurance Form  

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Marine Insurance Public Liability Insurance - Quick Quote NEEDS ANALYSIS FORM
This form is designed to gather general information from which to present to various Underwriters to obtain an indicative quote. You will most likely have to provide further information in due course.

  If your requirements exceed the scope of this form, please contact us for direct personal assistance.

Please ensure all required fields are filled in. They have been highlighted in red for your convenience.
Section 1

Location of Business
Country:   State:
Name of Business:
When was the Business Established:
Type of Work normally
carried out:
Structural Repairs to Hulls Yes   No        
Non Structural Maintenance of Hulls Yes   No        
Boat -/- Ship Construction Yes   No        
Diving Services Yes   No        
Mooring Laying & Repairs Yes   No        
Antifouling & Polishing Yes   No        
Spraypainting Yes   No        
Sand Blasting Yes   No        
Salvage & Recovery Yes   No        
Electrical Fitout and Repairs Yes   No        
Mechanical Fitout and Repairs Yes   No        
Mechanical Works to Motors Yes   No        
Installation Work to Motors Yes   No        
Rigging, Sail and Spar works Yes   No        
Welding, Metals Fabrication Yes   No        
Marina and Wharf Construction Yes   No        
What is the Maximum Value of Vessels to be worked on:   :
Does the Business include:
Hauling Out and Launching Yes   No        
(rail slipway, travel lift, floating dock lift, etc.)

Fuelling Yes   No        

Design Services (Marine Architecture) Yes   No        
Vessel Surveys (Condition Reports) Yes   No        

Will you require Insurance Cover on any Vessel the Business Owns and Operates
Yes   No          
During the ordinary course of business, are clients vessels motored or sailed on their behalf:
Yes   No          
Will the person motoring or sailing the vessel always hold a current commercial marine licence:
(coxswain certificate or competency - master classes etc)
Yes   No          
What was the Business's Gross $t/o for the past Financial Year   :
Estimate Gross $t/o for the current Financial Year   :
Does the Proposer engage
Yes   No          
Are Subcontractors required to carry their own Public Liability Insurance?
If No
, please provide details.
Yes   No          
Would you like to tell us anything more about business so that we can better understand it.
Does the business have a website
Section 2

Does the Proposer require
Public Liability Insurance
Yes   No          

If No, proceed to Section 3
In addition to public liability insurance to cover
the risks described above, does the Proposer
require the insurance to extend to:-
Pollution Insurance
Yes   No          
Property in Care Custody & Control
Yes   No          

Section 3
Has the Proposer made any insurance claims on their current or previous
insurance cover for this risk, or a similar risk for which insurance is sought:.
Yes   No  
or; been prosecuted or charged with offences relating to a breach of
Occupational Health & Safety Laws, or in respect of Employee laws:
Yes   No    
If Yes to any of the questions above, please give details:
Has the Proposer or the Person requesting this quote ever: -          
  a) been refused insurance: Yes   No  
  b) had an insurance claim of any type refused or reduced: Yes   No    
  c) been charged with a crime of any type: Yes   No    
If Yes to any of the questions above, please give details:
Is there anything else you would like to tell us that we should know: Yes   No    
If Yes please give details:

Section 4
Your Name
Preferred Method of Contact Phone     Email
Best Time to Call:  


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