Quotation Form for Crew Insurance, YACHTLINK International

Yachtlink Insurance provides crew accident and health insurance as well as Boat & Yacht Insurance

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One moment it's plain sailing ...
... next you might want to get a

Quotation for Crew Accident & Health Insurance

Click here >>> For a Quotation for a Boat Insurance

Please answer all questions fully and completely, and make sure you disclose all the material facts which are likely to influence our acceptance and assessment of your proposal form.
If you are in any doubt as to whether a fact is material or not you should disclose it. As Failure to do so could invalidate your insurance policy.

Please enter your Name, Address etc. below:
Full Name:
Address:

Town/City:	Post/Zip Code:
Country:
Telephone:
Mobile/Portable Phone:
Fax:
e-mail:

Nationality:	Date of Birth:
Heigth:	Weight:
Details of your Occupation:
Full Description of your Duties incl. details of any machinery used:
Give details of any Accidents, Injuries or Illness you have had in the last 10 years which has resulted in a claim being notified to insurers:
Give details of any Physical Defect, Infirmity or other Health Problem of any kind:
Give details if any Insurer has ever Declined Insurance, Refused Renewal, Imposed Terms or Terminated a Policy?

Declaration:
I, the applicant of this proposal form, declare that to the best of my knowledge and belief the statements and particulars in this proposal Form are true and complete.
I have not withheld or misrepresented any material Fact.
I agree to inform the company of any and all material alterations in my health, activities or occupation.


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