Ouest Assurances - Portail sécurisé

Customer

Title

Name

Firstname

Company

Address

Address (next part)

Postal code

City

Country

Main phone

Secondary phone

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Customer - Additional data

Date of Birth

Country of birth

City of birth

City of birth postal code

Boat

Use

Boat name

Boat type

Builder

Builder (other)

Model

Material

Year

Length (meters)

Total power (HP)

Flag

Parking harbor

Country of parking harbor

Department of parking harbor

Navigation area

Licence

Total value

How many years have you owned this boat?

Financement

Type de financement

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Désirez-vous être contacté ?

Engine 1 (optional)

Type

Brand

Brand (other)

Year

Power (HP)

Engine 2 (optional)

Type

Brand

Brand (other)

Year

Power (HP)

Annexe (optional)

Brand

Model

Year

Engine brand

Engine brand (other)

Trailer (optional)

Brand

Year

PTAC

Value

Insurance background

Insurer

Contract #

Number of years insured

Number of claims (during the last 5 years)

Total amount of compensation (during the last 5 years)

Option(s)

Assistance

Yachtcharter with or without skipper

Yachtcharter with skipper

Yachtcharter without skipper +

Yachtcharter without skipper

Residential mooring in Corsica

Sailing in the Lesser Caribbean

Legal protection

Regatta

Water skiing

Comment (optional)

Privacy Policy

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Yacht insurance quote

Customer

Customer - Additional data

Boat

Financement

Engine 1 (optional)

Engine 2 (optional)

Annexe (optional)

Trailer (optional)

Insurance background

Option(s)

Comment (optional)