Tow/Voyage Questionnaire
In addition to this application, please submit a company profile including: 5 year loss history + experience of crew (C.V.) &/or owner/operator + name, years and trade of vessels previously owned/operated + name of prior insurers.
Applicant / Assured
Name of owning company or individual name if a sole proprietorship
Your answer
Applicant / Assured address
Address of owning company or individual, if a sole proprietorship (e.g. 9420 SW 77th Ave. #200 Miami, FL 33156)
Your answer
Vessel Name
Your answer
Ex name
Your answer
Type of Vessel
e.g. General Cargo, Ro-Ro, Oil Tanker, Barge, Tug, etc...
Your answer
International Maritime Organization (IMO) #
should be a 7 digit number
Your answer
Year Built
e.g. 1989
Your answer
Deadweight (DWT)
Your answer
Gross Registered Tonnage (GRT)
Your answer
Voyage from
Name of City and Country of voyage origin (e.g. Barranquilla, Colombia)
Your answer
Voyage to
Name of city and country of final destination (e.g. Kingston, Jamaica)
Your answer
Via
Tow or under its own power
Your answer
Estimated Time of Sailing (ETS)
When is the voyage scheduled for
MM
/
DD
/
YYYY
Estimated Voyage Duration
e.g. 15 days
Your answer
Details if in damaged condition
Your answer
Details of present lay up position
Your answer
Length of lay up
How long has the vessel been laid up for? (e.g. 2 years)
Your answer
Purchase Price in USD
Your answer
Hull and Machinery (H&M) value required
Your answer
Reason for Voyage/Tow
e.g. break up, delivery, etc...
Your answer
Has vessel recently been operating?
Will voyage be in ballast?
Details of cargo, if any
Your answer
Does vessel have current class?
If so, will class be maintained?
What flag will vessel fly?
Your answer
Proposed crewing arrangement
Your answer
Proposed towing company (if applicable)?
Your answer
Signature
Print the name of the person submitting this form
Your answer
Email where we can contact you
Your answer
Phone # where you can be reached
Your answer
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