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PRIVATE - Risk assessment sport boats and yachts

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Are you the owner of the vehicle?

yes

If no, in what capacity are you related to the vehicle or is the insurance being applied for?

Birthday

Professional status

Are there third-party rights on the vehicle?

yes

If yes, what third-party rights exist on the vehicle?

Which driver's license do you have?

Driving area where you operate your vehicle

German inland waters

Berlin, Brandenburg and Mecklenburg inland waters

European rivers and inland waters

North and Baltic Sea

Mediterranean

Atlantic

other

Is the vehicle chartered?

yes

Chartering

with skipper

without skipper

If chartered: with or without skipper

Are you a member of a club?

yes

If yes, which club?

Is the vehicle used commercially?

yes

If yes, in what way is the vehicle used commercially?

Vehicle Location in Summer (Country / Postal Code / Address)

Vehicle Location in Winter (Country / Postal Code / Address)

Is it a motorboat?

yes

Type of Motorboat

Is it a sailboat?

yes

Type of Sailboat / Propulsion Type

Sail Area in sqm

Age and material of the mast

Age and material of the sail

Manufacturer

Type of Construction

Self-construction

Self-built

Model

Boat type

Multi-hull boat

Name of Vehicle

Year of construction

Year of acquisition

Purchase price in €

Seating places

Building material

Type of boat

Inflatable Boat

CE Number / Hull Number

Length in m

Width in m

Depth in m

Does the vehicle have a tracking system?

yes

If yes, type of tracking system

Registration location (country / postal code / city) and number

Number of inboard motors

Power of inboard motors in kW

Year of inboard motors

Make of inboard motors

Fuel for Inboard Motors

Engine Number(s) of Inboard Motors

Number of outboard motors

Power of outboard motors in kW

Year of outboard motors

Make of outboard motors

Fuel for Outboard Motors

Engine Number(s) of Outboard Motors

Number of auxiliary outboard motors

Power of auxiliary outboard motors in kW

Year of auxiliary outboard motors

Make of auxiliary outboard motors

Fuel for Auxiliary Outboard Motors

Engine Number(s) of Auxiliary Outboard Motors

Vehicle drive type

Z-drive number(s)

Is the maximum speed higher than 100 km/h?

yes

Is a dinghy present?

yes

Manufacturer of the Dinghy

Year of dinghy

Material of dinghy

Is a trailer present?

yes

Manufacturer of the Trailer

Year of trailer

Trailer vehicle identification number

Permissible total weight of the trailer in kg

Vehicle including permanently installed parts and machinery as well as accessories in €

Outboard Motor in €

Tender / liferaft in €

Auxiliary Outboard Motor in €

Personal Effects, Photo and Film Equipment, etc. in € Items required for water sports (e.g. onboard laundry, nautical equipment, diving gear, compasses, entertainment electronics, binoculars, etc.)

Trailer in €

Total value of vehicle, accessories, dinghy, auxiliary outboard motor, personal effects and trailer in €

Machinery plant in €

Auxiliary Diesel (Power Generators) in €

Pumps in €

Winch systems in €

Hydraulic units in €

Battery Systems in €

Stabilizers in €

Hatch opener in €

Onboard crane and lifting equipment in €

Heating and air conditioning systems in €

Other mechanical equipment in €

Auxiliary Outboard and Dinghy Motors in €

Total value of machinery and mechanical equipment in €

Radar systems in €

GPS and AP Navigators in €

Self-Control Systems in €

Rowing machine indicator in €

Echo sounders in €

Fog signal systems in €

Electronic compasses in €

Marine Chartplotter in €

Fixed onboard radio / onboard telephone systems in €

Fixed onboard radio / onboard TV systems in €

Antenna systems in €

Measuring equipment (e.g. wind, km/h) in €

Gas Detection Devices in €

Navtex receiver in €

Weather fax in €

Fixed PC systems and monitors in €

Tank readings in €

Solar cell systems in €

Chargers in €

Control Panels in €

Converter in €

Charging current regulator in €

Other electrical installations in €

Total value of electronic equipment in €

Desired Coverage Amount of Vehicle Liability Insurance (flat rate)

€3 million

€5 million

€15 million

Comprehensive insurance for vehicle and trailer desired?

yes

Machinery insurance for machinery plant and mechanical equipment desired?

yes

Electronics insurance for electronic equipment desired?

yes

Desired deductible

none

150 €

250 €

500 €

Payment method

Account

BLZ

Account holder

Credit institution (at)

IBAN

Is or was there prior insurance?

yes

Previous insurance – Company

Previous Insurance – Contract Number

Termination by

Have there been any prior damages in the last 5 years?

yes

No claims since (if no prior damages)

Number, date, type and amount of prior damages

Is additional insurance coverage desired? (e.g., passenger accident, legal protection, warranty extension)

yes

If yes, what additional insurance coverage is desired?

Other notes, remarks

Bei den Fragen handelt es sich um Fragen über gefahrerhebliche Umstände. Unvollständige oder unrichtige Angaben können den Versicherer zum Rücktritt oder zur Kündigung des Vertrages berechtigen. Die Daten werden zur weiteren Verarbeitung gemäß Einwilligungserklärung zur Datenverarbeitung an Versicherer und Dienstleister weitergeleitet.

Date (Signing)

Customer's signature

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