Hull Insurance Proposal form

1- A. Name in full
B. Address

2- A. What trade is vessel engaged upon and nature of cargo carried?
B. Is vessel ever towed or used as tug? If so, Also answer question 18, 19, and 20.

3- Master, officers and crew:-

Give details of Nationality and maritime experience.

4- What are the trading limits?

5- Give full details of current / last insurances:-

A. insured value
B. Insurance conditions
C. Rate
D. Statistics of premiums and claims over the past five years shown separately.
Show any outstanding claims separately.

E. Show, in brief, details of any major losses.

6- What insurance covered is required?

7- State period of insurance required

8- For what amount do you wish to insure:-

A. Hull and equipment
B. Machinery and Boilers
C. Other interest

9- A. Name of vessel
B. Where built, when by whom?
C. Where Registered.
D. Registered Number
E. tonnage :
F. Number in register book.

10. State type of vessel (i.e - Steamer, tug, Motor Launch, etc.)

11. What is construction (i.e - Wood, (state kind of wood), steel, iron, etc.)?

12. What navigational aids are fitted?

13. Dimensions

A. Length
B. Beam
C. Draught Loaded
D. Molded Depth

14. State type of engine(s) H.P. And fuel used

What is maximum designed speed of vessel?

15. Has the vessel recently been overhauled or any major repairs undertaken? If so, please give details.

16. When was vessel last surveyed, where and by whom? Please supply copy of the last survey report.

17. How often are surveys conducted?

18. If your vessel is towed give details of the tugs normally used, whether the tugs art used for soy Purpose other than towage. Also experience and nationality of the owners and crew.

19. What is the maximum number of vessels towed any one time, by any one tug?

20. Is there any local or governmental authority which supervises towage? Is any special license required?

21. For what geographical limits is insurance required?
NB As the insurance of the vessel will be restricted to the above geographical limits, it is important to state your requirement clearly.

22. Is the vessel at present insured with any other insurer? If so, please give name of the insurer and brief details of the cover

23. Is the vessel classed with a recognized classification society? If so, state symbols assigned.

24. Is the vessel covered in forward, Aft and Round sides?

25. State the cruising speed of the vessel.

26. State the reason for the difference between the purchase price and the amount proposed for insurance.
Maker's Name
Type of engine
Fuel used & quantity on board
Is reverse gear provided
No. of propellers
Horse Power
No. of cylinders
Type of engine No. and Casing

26. Particulars of Master and Crew:-

A. Is the vessel in her charge of a qualified master?
B. State his qualification
C. How long has been your employee?
D. Will he live ahead the vessel?
E. If not in charge of qualified master state brief details of the person who will be in charge of the vessel.

28. What is the total number of crew on board the vessel?

I hereby declare that, to the best of my knowledge and belief, the particulars and answers are true and correct and that I have no other information which might influence the decision of the company in regard to this proposal.
Signing this form does not bind the proposer to complete the insurance, but it is agreed that the information given by the proposer on this form shall be the basis of the contract. If, subsequently, a policy is issued, it should be carefully examined by the insured as the policy is the actual contract.
To be used for Additional Information where the space provided in the proposal form is insufficient. Kindly indicate the number of the question to which you refer.