Darlow Marine Insurance

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Darlow Marine Insurance - P&I APP

Darlow Marine Insurance application for Protection & Indemnity.

Shipowner: *

Company name

Address: *

Address

Phone #:

Telephone number

E-mail:

E-mail address

Operator/Manager's name: *

Company name

Address: *

Street address

Phone #:

Telephone number

E-mail:

E-mail address

Vessel name: *

IMO#: *

Year built:

Flag:

Classification society:

Length, Breadth & Draft:

Type of vessel: *

Ro-Ro, General, Tug, Barge, etc..

Hull value: *

Vessel hull value

P&I limit of liability required *

What P&I limits do you require or desire?

Is pollution coverage needed?

Yes

No, applying seperately

Clear selection

Is a Blue Card needed?

Yes

Clear selection

If Blue Card is needed, please provide the Call Sign

Deadweight:

GRT: *

Gross Registered Tonnage

NRT:

Type of cargo carried:

Navigation limits / Trading area: *

5 Year loss history *

(Date of loss, Vessel name, Description of incident, Amount paid by company, if any? If no losses, please specify 'No losses')

Additional comments:

Signature of applicant *

Title *

Vessel owner, Operator, Representative, President-CEO-Director of <Company Name>

Email *

The quotation will be sent to this email.

Submit

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