Personal Details
Assured's Name*:    
Address*:
Postcode*:
Telephone*: Email:
Age:  years Experience:  years


Vessel's Details
Vessel Name: Skipper's Experience*:  years
Type of Vessel*: Vessel Flag*:
Hull Material*: Builder:
Year Built*: Gross Tons*:
Max Speed*:  knots Length*:  
Date of last independent survey (if you have one):


Engine's Details
Make of Engine: Year of Make*:
Power:   Value:  
Date of last Major Overhaul:    


Vessel's Use
Cruising/Fishing Limits*:
Type of Fishing Operation
(e.g. Trawling,
Potting)*: 		Type of Licence/Category:
Mooring Location: Mooring Type:
  If your cruising/fishing limits or mooring type are not included in the options above then please select 'Other' and make a note in the additional information section.


Cover Details
Total Sum Insured*:   No Claims Discount*:
Crew Liability*:  Yes    No If yes, number of Crew (exc. owner):
    Insurance Start Date*:
Current Insurers:    
Have you had any claims in the last 5 years*?  Yes    No
  If yes, please provide details in the box below including the date & value of each claim.
 
Personal Accident Cover:  Yes    No
If yes, number of men: Limits:  
  Any additional information, or if your preference isn't included in the above sections then please make a note here:
 
Where did you hear about Velos*:
If you have a reference number, please quote it here:
 

 Once you are happy your details are correct, click 'Submit Enquiry' to
 submit your enquiry to Velos Insurance Services.

 We will endeavour to respond to your enquiry within one working day.

 * these fields are compulsory.