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Contact
information
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Company Name
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Address
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Telephone
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Facsimile
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Email
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Contact Name
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Surface equipment to be insured
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Surface equipment item 1
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Insurance amount required item 1
(USD please) |
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Surface equipment item 2
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Insurance amount required item 2
(USD please) |
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Surface equipment item 3
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Insurance amount required item 3
(USD please) |
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| Liability Limit
Required (Third Party or P&I) (USD please) |
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Please attach a list of additional
surface equipment in the same format
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Sub-surface equipment to be insured
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Sub-surface equipment item 1
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Insurance amount required item 1
(USD please)
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Sub-surface equipment item 2
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Insurance amount required item 2
(USD please) |
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Sub-surface equipment item 3
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Insurance amount required item 3
(USD please) |
Currency converter |
| Liability Limit
Required (Third Party or P&I) (USD please) |
Currency converter |
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Please attach a list of additional sub-surface equipment in the same
format
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How will the above equipment be used?
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Please provide an outline of existing
contracts and anticipated contracts where the above equipment will be used
including location, project name and other pertinent details.
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Who, other than the Applicant's full
time personnel will operate and maintain the equipment?
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If personnel is not your full time
staff, does the Applicant have control over the appointment and/or
supervision of these individuals? (Please explain) |
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If this equipment is diving equipment
please state qualifications of the divers and supervisory personnel.
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Applicant detail
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Date Company established
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Who are the Officers of your Company?
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Sales last 12 months (USD) |
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Sales forecast for next 12 months
(USD) |
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Safety and operational matters
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Please provide details on the
Applicant's experience in the operation or the proposed operation and use
of the above equipment
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Please provide details of the
Applicant's procedures for reporting and responsibility (the management
chain)
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Please provide details of operation and
safety manuals and procedures and the procedures for monitoring and
implementation (if none-state no safety program)
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Will you carry passengers for hire?
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If so, how many per trip?
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If so, how many trips per day?
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How will the passengers be boarded?
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Claims history
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Provide complete detail of all claims,
insured or otherwise, involving all underwater or related equipment for
which the Applicant owned, operated or was responsible for in the
preceding five (5) years.
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What steps have been taken to prevent
re-occurrence?
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Remarks
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Please provide any further information
you feel is important to assist underwriters is properly assessing your
proposal and provide the most competitive quotation
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