Marine Professional Insurance For Marine Surveyors and Consultants

Contact Information

Contact Name

Address

City

State

Zip/Postal Code

Country

Phone Number

Email

Company Website

Position

Company and Personnel Information

How long has your company been in operation?

Please describe your services and area(s) of expertise, and also indicate any major clients:

Please provide the following information regarding the company's personnel:
Number of Directors, Senior Managers, Surveyors or Consultants
Number of Clerical Staff
**It may be necessary to provide us with details outlining the experience and professional qualifications of your principle surveyors/consultants.

Please provide the following Annual Income information (please specify currency, e.g. USD). Annual Income = fees and commissions only charged to your customer:
Annual Income (estimated for this financial year)
Annual Income (estimated for next financial year)

What percentage of your annual income relates to work in the offshore oil and gas industry?

Do you issue or carry out any of the following?
Gas Free Certificates* Yes No
Quality or Quantity Certificates* Yes No
Overseeing Bunker Supply Yes No
Surveying Cargo Holds for the Loading of Petroleum-related Products Yes No
*If yes, you may be required to provide sample certificates.

Do you perform surveys on yachts and/or pleasure craft? Yes No
If so, what percentage of your annual income is derived from this activity?

Trading Conditions

Do you have any standard trading conditions or contracts? If yes, please provide a copy.
Yes No

Do you ensure that they are always provided to a customer before accepting service?
Yes No

Do you include a disclaimer / liability clause in all your reports or written advice to customers? If yes, please provide a typical example.
Yes No

Claims History

In the last five years have you had any professional liability claims made against you?
Yes No
If yes, please provide full details:

Have there been any circumstances that could have resulted in a professional liability claim being made against you?
Yes No
If yes, please provide full details:

Current Insurance

Are you currently insured for your professional negligence exposure? Yes No

Do you require a specific deduction and / or limit of liability to be quoted?

Other Information

Has any insurer ever declined to insure you, cancelled your insurance, refused to renew your insurance, or imposed special terms?
Yes No
If yes, please provide full information.

Who are your current insurers?

Who are your current brokers?

What is your current premium?

Please provide any further information that may be material to the insurers:

Please provide the following:
Company Name
Date Position

Important Note: The questions contained in this form are designed to give insurers information regarding your business. It may not address every aspect and it is your duty to disclose all material information to insurers that may affect the premium or conditions.