Seippel & Light marine insurance
for high-value luxury motor and sailing yachts
TEL: +34 971 10 00 70 
DATE:
NAME OF INSURED:
ADRESS OF INSURED:
EMAIL:
TELEPHONE:
NATIONALITY OF BENEFICIAL OWNER:
DATE OF BIRTH:
PROFESSION:
EXPERIENCE/QUALIFICATIONS OF OWNER:
EXPERIENCE/QUALIFICATIONS OF SKIPPER:
CURRENT INSURER:
RENEWAL DATE:
NO CLAIMS BONUS:
CLAIMS IN LAST 5 YEARS:
NAME OF YACHT:
VALUE HULL & MACHINERY:
BUILDER, MAKE & MODEL:
OVERALL LENGTH:
CONSTRUCTION MATERIAL:
YEAR OF BUILD:
FLAG:
GROSS TONNAGE:
PRIVATE USE OR SKIPPER OR BAREBOAT CHARTER:
NUMBER AND MAKE OF ENGINES
HORSEPOWER OF EACH:
SAIL AREA ON THE WIND:
MAX DESIGN SPEED:
FUEL TYPE:
CRUISING AREA REQUIRED:
PERMANENT MOORING LOCATION:
WATERSKIERS LIABILITY:
DETAILS OF PERMANENT &/OR SEASONAL CREW:
REGATTA COVER:
VALUE OF MAST, SPARS & SAILS:
MORTGAGE:
COMMENTS: