Policy Number:

Full Name:

Occupation:

Day Phone No:

Day Fax No:

Home Phone No:

Home Fax No:

Home Address:

Post Code:

E-mail Address:

Are you registered as a taxable person for VAT?

No Yes

Was there any other insurance covering this craft at time of loss?

No Yes

Were you helming or last person in charge of craft prior to loss?

No Yes

Class:

Builder:

Year Built:

Current Value:

Name:

Sail Number:

Hull Number:

Hull Material:

Spar Material:

State fully the purpose the craft was being used for

If under way, names of passengers/crew

Date It Occurred

Exactly Where?

Wind Force

If Club or Marina: Name:

What Happened?

Why Did That Happen?

Is Anyone Else To Blame?

If so, Their Name

  Their Address

    Their Insurer

 Why it's Their Fault

Detail Your Loss-Damage

Where Can Damage Be Inspected

Name/Address or Repairer You Would Like To Use

If Theft, Police Station: Name:

    Address:

    Phone:

    Reference:

    If other craft damaged by you & your fault please state that owners:

    Name:

    Address:

   Their Insurer:

   Any other information you feel will be helpful to insurers please state below:

   If you have any specific questions please state them below: