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 (3.5% - min.: 85€)  Infinite Cancellation Cover (4% - min.: 95€)
  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.: 85€) No
Sub-total : 0,00 €
Excess payback
   Premier (3.5% - min.: 85€) Infinite (5.5% - min.: 285€ - max.: 2 weeks) Infiniterc (8% - min.: 400€ - max.: 2 weeks)
   Premier regatta (7% - min.: 170€) Infinite regatta (11% - min.: 570€) 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.