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Marine Hull Application Form - Blanka Panther
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Blanka Panther

Marine & Aviation Insurance Company

Marine Hull Application Form

Insured
Name
Company
E-mail
Phone
Owner
Management
Vessel
Name Flag
IMO Number Year of Built
Classification society Trading area
Claims Record
Please indicate date, nature of any claim (s) and amount of claim(S) for period of last 5 years for each vessel including any other vessels under management of Insured for this period.
Date of inception
Period of Insurance
From to
Is RDC (collision liability) needed within H&M cover? Yes No