GH Insurance

Blue Water Rallies Yacht Application Form

Please fill in the form below.
* Required fields

PERSONAL DETAILS
* Name:
* Address:
* Postcode:
* Telephone:
* Email address:
CREW DETAILS
* Number of Crew (including Skipper):
Give details of occasions when crew number will differ from that stated above:
BLUE WATER PARTICIPATION
Please select the Blue Water events that you will attend:
Full Blue Water Rally:
Oz-Med Rally:
Rally Antigua:
Biscay Triangle:
Other: (include details of pre-rally cruising which you would like to cover and date from which cover required)
Please give details
CRAFT DETAILS
*Type/class of craft:
*Name of craft:
*Year of build:
* Material:
* Length:
Beam:
* Country of registration :
* Total insured value (including dinghies, outboards and personal effects):
ENGINE DETAILS
Make:
Fuel:
Horsepower:
Maximum speed:
OTHER INFORMATION
* Have you had any claims in the last five years?	Yes (please provide details below) No
Details of claims in past five years:
* Experience and Qualifications:
Details of any accidents in the past 5 years:
Current Insurer:
Current No Claims Bonus:
Renewal Date:

(N.B. A material fact is one likely to influence acceptance or assessment of this Application by Insurers. If you are in any doubt as to whether a fact is material or not, you must declare it. Non-disclosure or misrepresentation of a material fact may entitle Underwriters to void the Insurance.)