Customer Title Association Works council EURL High school Madam Sirs Mister Dear Madam, dear Sir SA SARL SAS SASU SCI SCP SNC Société Company Name Firstname Address Address (next part) Postal code City Country South Africa Albania Algeria Germany Andorra Andorra Angola Antigua and Barbuda Netherlands Antilles Saoudi Arabia Argentina Armenia Australia Austria Bahamas Bahreïn Barbados Belgium Belize Benin Bermudes Belorussia Birmanie Brazil Brunei Bulgaria Canada Cape Verde Chili China Cyprus Colombia Corse Costa Rica Ivory coast Croatia Cuba Denmark Dominica Egypt United Arab Emirates Equator Spain Spain except Canaria islands Estonia United States Ethiopia Finland France Gabon Ghana Greece Grenada Guadeloupe Guatemala French Guiana Hong Kong Hungary Mauritius Island India Indonesia Ireland Island Israël Italy Japan Jordania Kazakhstan Koweït Reunion island Latvia Lebanon Liechtenstein Lituania Luxembourg Macao Madagascar Malaysia Malawi Maldives Malta Morocco Martinique Mexico Moldavia Monaco Norway Nouvelle-Caledonie New-Zealand Oman Pakistan Panama Paraguay Netherlands Peru Philippines Poland French Polynesia Portugal Portugal except Açores islands Qatar Dominican Republic Czech Republic République yougoslave de Macédoine Reunion island Romania United Kingdom Russia Saint-Barth San Marino Saint-Marteen Saint-Vincent and Grenadines islands Saint Lucia Senegal Serbie Seychelles Singapour Slovakia Slovenia Sweden Switzerland Thailand The Netherlands Tunisia Turkey Ukraine Uruguay Vatican Venezuela Yougoslavia Main phone Secondary phone Email Boat Use School boat Location avec skipper Location sans skipper Plaisance Régate Boat name Boat type Catamaran Catamaran (motor) Jet-Ski PENICHETTE Inflatable TRIMARAN Launch Yacht Builder Constructeur (autre) 3C COMPOSITE voir OLEA MER ACCF ACTION NAUTIQUE ADN - EDEL CATAMARANS AFEP MARINE AKILARIA ALIZE YACHT DESIGN ALLIAGE ALLIAURA MARINE ALLURES YACHTING ALP MARINE ALPHENA YACHTS ALUBAT AM AMEL ANTILA Yachts ARCHAMBAULT ASTRAEA ASTUS BOATS B2 MARINE BALOIN BARRAMUNDI BAVARIA BENETEAU BLACK PEPPER - CN de LARROS BORD A BORD BOREAL BRITISH HUNTER BROADBLUE CATAMARANS CAP'EAU'LARGE CATANA CHALLENGER CHANTIER MAREE HAUTE CHANTIER NAVAL JEZEQUEL CHANTIER NAVAL STAGNOL CHANTIER NAVAL STRUCTURES COMAR YACHTS CONSTRUCTION NAUTIQUE DE GASCOGNE CONTEST YACHTS CORNISH CRABBERS CORSAIR MARINE DEAN CATAMARANS DEHLER DEL PARDO - GRAND SOLEIL DELPHIA YACHTS DINAMICA DIVA - GROUPE PONCIN DRAGONFLY DUFOUR DUJARDIN EDEL CATAMARANS ELAN ESPACE VAG ESTUAIRE MARINE ETAP FEELING FORA MARINE FOUNTAINE PAJOT FRANCE CATAMARAN FRANCK ROY FTM GARCIA GIB SEA GL COMPOSITES HALLBERG - RASSY HANSE HARMONY - GROUPE PONCIN YACHTS HEOL HUNTER MARINE HUNTER YACHTS IDB MARINE INDIGO YACHT J BOATS JEANNEAU JPK COMPOSITES JYPLAST LAGOON LATINI MARINE LATITUDE 46 LEOPARD CATAMARANS LOCMERAL YACHTS M 2 M MAC GREGOR MAXUS MERY NAUTIC META MOODY NACRA NAJAD NAUTICAT - SILTALA YACHTS NAUTITECH CATAMARANS NAVAL FORCE 3 NEEL TRIMARANS NORDSHIP by BUCHWALD Yachts OCQUETEAU OLEA MER OUTREMER PACER YACHTS PICHAVANT PRIVILEGE MARINE RONAUTICA RUSTLER SAILART SALONA SIRENA VOILE SOLARIS SUNBEAM YACHTEN SWALLOWBOATS TES TOURNIER MARINE VARIANTA - HANSE Group VIKO Yachts WAUQUIEZ WESTERLY YACHTS WRIGHTON X - YACHTS 3D TENDER ABSOLUTE ACCF ACTION NAUTIQUE ADN - EDEL CATAMARANS AFEP MARINE AKILARIA ALIZE YACHT DESIGN ALLIAGE ALLIAURA MARINE ALLURES YACHTING ALP MARINE ALPHENA YACHTS ALUBAT AM AMEL ANTILA Yachts ARCHAMBAULT ASTRAEA ASTUS BOATS B2 MARINE BALOIN BARRAMUNDI BAVARIA BENETEAU BLACK PEPPER - CN de LARROS BORD A BORD BOREAL BRITISH HUNTER BROADBLUE CATAMARANS BWA CAP'EAU'LARGE CATANA CHALLENGER CHANTIER MAREE HAUTE CHANTIER NAVAL JEZEQUEL CHANTIER NAVAL STAGNOL CHANTIER NAVAL STRUCTURES COMAR YACHTS CONSTRUCTION NAUTIQUE DE GASCOGNE CONTEST YACHTS CORNISH CRABBERS Correct craft CORSAIR MARINE DEAN CATAMARANS DEHLER DEL PARDO - GRAND SOLEIL DELPHIA YACHTS DINAMICA DIVA - GROUPE PONCIN DRAGONFLY DUFOUR DUJARDIN EDEL CATAMARANS ELAN ESPACE VAG ESTUAIRE MARINE ETAP FEELING FORA MARINE FOUNTAINE PAJOT FRANCE CATAMARAN FRANCK ROY FTM GARCIA GIB SEA GL COMPOSITES HALLBERG - RASSY HANSE HARMONY - GROUPE PONCIN YACHTS HEOL HUNTER MARINE HUNTER YACHTS IDB MARINE INDIGO YACHT J BOATS JEANNEAU JPK COMPOSITES JYPLAST LAGOON LATINI MARINE LATITUDE 46 LEOPARD CATAMARANS LOCMERAL YACHTS M 2 M MAC GREGOR MAXUS MERY NAUTIC META MOODY NACRA NAJAD NAUTICAT - SILTALA YACHTS NAUTITECH CATAMARANS NAVAL FORCE 3 NEEL TRIMARANS NORDSHIP by BUCHWALD Yachts OCQUETEAU OLEA MER OUTREMER PACER YACHTS PICHAVANT PRIVILEGE MARINE RONAUTICA RUSTLER SAILART SALONA SIRENA VOILE SOLARIS SUNBEAM YACHTEN SWALLOWBOATS TES TOURNIER MARINE VARIANTA - HANSE Group VIKO Yachts WAUQUIEZ WESTERLY YACHTS WRIGHTON X - YACHTS Builder (other) Model Year Length (meters) Total power (HP) Flag GERMANY AUSTRIA BELGE BELGIUM CYPRUS DENMARK SPAIN FRANCE GREC IRELAND ITALY JERSEY LUXEMBOURG MALTA MONACO NORWAY THE NETHERLANDS PAYSBAS PORTUGAL UNITED KINGDOM SWEDEN UK Parking harbor Country of parking harbor South Africa Albania Algeria Germany Andorra Andorra Angola Antigua and Barbuda Netherlands Antilles Saoudi Arabia Argentina Armenia Australia Austria Bahamas Bahreïn Barbados Belgium Belize Benin Bermudes Belorussia Birmanie Brazil Brunei Bulgaria Canada Cape Verde Chili China Cyprus Colombia Corse Costa Rica Ivory coast Croatia Cuba Denmark Dominica Egypt United Arab Emirates Equator Spain Spain except Canaria islands Estonia United States Ethiopia Finland France Gabon Ghana Greece Grenada Guadeloupe Guatemala French Guiana Hong Kong Hungary Mauritius Island India Indonesia Ireland Island Israël Italy Japan Jordania Kazakhstan Koweït Reunion island Latvia Lebanon Liechtenstein Lituania Luxembourg Macao Madagascar Malaysia Malawi Maldives Malta Morocco Martinique Mexico Moldavia Monaco Norway Nouvelle-Caledonie New-Zealand Oman Pakistan Panama Paraguay Netherlands Peru Philippines Poland French Polynesia Portugal Portugal except Açores islands Qatar Dominican Republic Czech Republic République yougoslave de Macédoine Reunion island Romania United Kingdom Russia Saint-Barth San Marino Saint-Marteen Saint-Vincent and Grenadines islands Saint Lucia Senegal Serbie Seychelles Singapour Slovakia Slovenia Sweden Switzerland Thailand The Netherlands Tunisia Turkey Ukraine Uruguay Vatican Venezuela Yougoslavia Navigation area Antilles Corse Eaux intérieures Standard Licence Côtier Fluvial Hauturier Mer Sans permis Total value How many years have you owned this boat? Engine 1 (optional) Type Diesel - In board Electrique Essence - Hors bord Essence - In board Brand (Autre - Spécifier) A préciser Beaudoin Beta Marine Bmw Caterpillar Craftsman Marine Cummins DAF Deutz Evinrude Excalibur Ford General Motors Honda Indenor Indmar Iveco Iveco Jet Johnson Leroy Somer Lister Petter Lombardini LUGGER Man Mariner Mercedes Mercruiser Mercury Midif Mtr annexe Murena Nanni NC Parson Perkins Peugeot Renault Renault Couach Rotax Seenergie Selva Steyr Suzuki Tohatsu Torqeedo Toshiba Vetus Vivian Volkswagen Volvo Yamaha Yanmar Brand (other) Year Power (HP) Engine 2 (optional) Type Diesel - In board Electrique Essence - Hors bord Essence - In board Brand (Autre - Spécifier) A préciser Beaudoin Beta Marine Bmw Caterpillar Craftsman Marine Cummins DAF Deutz Evinrude Excalibur Ford General Motors Honda Indenor Indmar Iveco Iveco Jet Johnson Leroy Somer Lister Petter Lombardini LUGGER Man Mariner Mercedes Mercruiser Mercury Midif Mtr annexe Murena Nanni NC Parson Perkins Peugeot Renault Renault Couach Rotax Seenergie Selva Steyr Suzuki Tohatsu Torqeedo Toshiba Vetus Vivian Volkswagen Volvo Yamaha Yanmar Brand (other) Year Power (HP) Annexe (optional) Brand Model Year Engine brand (Autre - Spécifier) A préciser Beaudoin Beta Marine Bmw Caterpillar Craftsman Marine Cummins DAF Deutz Evinrude Excalibur Ford General Motors Honda Indenor Indmar Iveco Iveco Jet Johnson Leroy Somer Lister Petter Lombardini LUGGER Man Mariner Mercedes Mercruiser Mercury Midif Mtr annexe Murena Nanni NC Parson Perkins Peugeot Renault Renault Couach Rotax Seenergie Selva Steyr Suzuki Tohatsu Torqeedo Toshiba Vetus Vivian Volkswagen Volvo Yamaha Yanmar Engine brand (other) Trailer (optional) Brand Year PTAC Value Insurance background (optional) Insurer Contract # Number of years insured Number of claims (during the last 24 months) Total amount of compensation (during the last 24 months) Option(s) Assistance Non Oui Yachtcharter with or without skipper Non Oui Yachtcharter with skipper Non Oui Yachtcharter without skipper + Non Oui Yachtcharter without skipper Non Oui Residential mooring in Corsica Non Oui Sailing in the Lesser Caribbean Non Oui Legal protection Non Oui Regatta Non Oui Water skiing Non Oui Comment (optional)