PURCHASE - STEP 1/3

Please click the following link to download the application form to be returned and held by us:


or fill in the form below :
Fields in bold are mandatory
Person in charge on board
 
Last name : First name :
Address :
Post code/Zip number : Town/City : Country :
Email : Telephone :
 
Skipper
 
Please click here if the skipper is not the person in charge on board
 
Package
 
Charter company : Charter price : €
Departure date : Return date :
Port of embarkation : Air or land transport cost : €
Boat make and model : Amount of the excess for the boat : €
 
Cancellation cover
Policyholder n°1
Last name First name Nationality Email
Amount paid for the charter and transport by policyholder1:  €
Cover :  Premier Cancellation Cover (3% - min.: 65€)  Infinite Cancellation Cover (3% - min.: 80€)
  Sub-total : 0.00 €
 
List of insured passengers :
Last name First name Nationality
Add another person
Add an policyholder
 
"Carefree sailing" cover
  Yes (3% - min.: 80€) No
Sub-total : 0.00 €
Excess payback
   Premier (3% - min.: 55€) Infinite (5% - min.: 250€ - max.: 2 weeks) Infiniterc (7% - min.: 380€ - max.: 2 weeks)
   Premier regatta (6% - min.: 110€) Infinite regatta (8% - min.: 450€) No
Sub-total : 0.00 €
Account charges : 15.00 €
  Total : 0.00 €
 
 
Under the French Data Protection Act (Loi Informatique et Libertιs), you have a right of access and rectification of your personal data. You can exercise this right by sending us an e-mail. This information is intended for the insurance company and are necessary to process your account.