Motor Insurance Fact Find

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Claims & Convictions
Have you or any person who may use the vessel been convicted or charged but not tried of any criminal offence?

YesNo
Have you suffered any claims or losses irrespective as to whether a claim was made in the last 5 years?

YesNo
Have you or any person that may use the vessel had any insurance refused, declined, cancelled or had special terms imposed?

YesNo
Have you or any person who may use the vessel ever been declared bankrupt or have any County Court Judgements registered against you?

YesNo
If you have answered 'Yes' to any of the Claims ∓ Convictions questions above please give details below.
Claims & Convictions Details
Additional Information
If there is any other information that you want to tell us, please detail this below
Additional Information
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