TM-2103 AVEVA Marine (12.1) Hull Detailed Design - Curved Hull Modelling Rev 4.0
Marine Hull Proposal Formtrimarine.co.za/Dowloadable files/Claims/Marine Hull... · Web viewALL...
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Transcript of Marine Hull Proposal Formtrimarine.co.za/Dowloadable files/Claims/Marine Hull... · Web viewALL...
MARINE HULL QUESTIONNAIRE
SECTION 1 – DETAILS OF VESSEL
Vessel’s Name:
Builder:
Where Built:
Hull Details: Year Built:
Material:
Length:
Tonnage:
Gross:
Special Equipment Fitted (eg, Sonar, Radar, V.H.F etc) :
Machinery Details: Engine Year Built:
If Reconditioned, Year:
Make & Model:
H.P.
Date of Last Overhaul:
Since last Overhaul:
Maximum Designed
Speed:
Details of any major refit / overhaul on Hull over last 5 years:
Date:
Approximate Cost:
Details:
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Details of any major refit / overhaul on Machinery over last 5 years:
Date:
Approximate Cost:
Details:
Does the vessel hold a current DOT Survey Certificate?
YES
NO
N/A
Expiry Date:
SECTION 2 – DETAILS OF OPERATION
Port of Operation:
Area of Operation:
Approximate period vessel is laid up each year:
Where is vessel kept when out of commission?
Type(s) of fishing:
Total number of crew:
Consisting of:
We must be advised if the vessel is used at any time for operations other than fishing, or if the fishing
method changes.
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SECTION 3 – DETAILS OF OWNERSHIP
Owner name (show names of all owners):
Address:
Postal Code:
Telephone No.
Date of Purchase:
Purchase Price Paid (excl VAT):
Are you registered for VAT?
YES
NO
Has the vessel previously been insured in current ownership?
YES
NO
Name of Insurer:
How long have you
owned fishing vessels? Years
Give details (name,
size, type, etc):
Details of previous loss
record:
Year Details Amount
2010
3
2011
2012
ALL OWNERS : Give details of all accidents / losses (whether an insurance claim or not) on any vessel
under your control or ownership in the last 3 (three) years.
Have you ever been involved in any major damages or Total Losses on any vessel in which you have or
have had a financial interest, or which was under your control?
If yes, give details, date, costs and name of vessel(s) involved.
YES
NO
Was the incident subject to a DOT inquiry?
YES
NO
If yes, give details and
outcome:
Was the incident subject to an insurance claim?
YES
NO
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If yes, give name of insurer and advise outcome of claim.
Previous Insurance Record.
In respect of this, or any other vessel owned or commanded by you, has any Insurer:
a) Declined Cover?
YES
NO
b) Cancelled or declined to renew cover?
YES
NO
c) Imposed loadings, restricted terms or additional premiums?
YES
NO
If yes, give full details:
Other Information.
Have you or any person involved in the ownership of this vessel ever been charged with or convicted for
any offence involving dishonesty of any kind e.g. fraud, arson, robbery, smuggling, theft, handling stolen
goods, etc ?
YES
NO
If yes, give full details:
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SECTION 4 – DETAILS OF MAIN SKIPPER
Name of main skipper:
Date of birth:
Address:
Postal Code:
Telephone No:
Certificates /
qualification held:
Total Fishing
experience: Years
Length of service with
proposed vessel: Years
How long has the
skipper commanded
fishing vessels?Years
Give details (name,
size, type, etc):
Knowledge of waters
to be sailed:
Other relevant
experience:
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Details of previous loss
record:
Year Details Amount
2010
2011
2012
Give details of all accidents / losses (whether an insurance claim or not) on any vessel under your control
or ownership in the last 3 (three) years.
Have you ever been involved in any major damages or Total Losses on any vessel owned or commanded
by you ?
YES
NO
If yes, give details, date, costs and name of vessel(s) involved.
Was the incident subject to a DOT inquiry
YES
NO
If yes, give details, date, costs and name of vessel(s) involved.
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Was the incident subject to an insurance claim?
YES
NO
If yes, give name of insurer and advise outcome of claim:
Previous Insurance Record
In respect of this, or any other vessel owned or commanded by you, has any Insurer:
a) Declined Cover?
YES
NO
b) Cancelled or declined to renew cover?
YES
NO
c) Imposed loadings, restricted terms or additional premiums?
YES
NO
If yes, give full details:
Other Information.
Have you or any person involved in the ownership of this vessel ever been charged with or convicted for
any offence involving dishonesty of any kind e.g. fraud, arson, robbery, smuggling, theft, handling stolen
goods, etc ?
YES
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NO
If yes, give full details:
SECTION 5 – VALUES TO BE INSURED
a) Hull & Machinery
b) Electronics (including hired). Detailed valued list required
c) Special Equipment Fitted. Detailed valued list required
If the requested information is not provided for B or C, cover will be restricted to total loss following
actual total loss of the vessel. If insufficient space please supply information on a separate sheet.
If the sum insured requested is higher than the purchase price, please advise reason:
d) Fishing Gear. Include total value of gear, both on board and stored ashore.
e) Dinghy / tender (used only in conjunction with proposed vessel.
Dinghy Age:
Size:
Material:
Value:
Outboard Age:
Type:
H.P.
Value:
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Premium payment method required:
Annually Half-Yearly Quarterly
CONTACT DETAILS:
Tri – Marine Acceptances (Pty) Ltd
67 Dreyersdal Road, Bergvliet 7945
P.O Box 347, Plumstead, 7801
Tel No: (021) 7131910
Fax No :(021) 7131910
Cell No: 083 309 3334 – Ian Smith
Email Address: [email protected]
Company Registration No: 2012/089555/07
Juristic Representative of Infiniti Insurance Ltd. FSP 35914
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