Protection Indemnity Proposal Form Page 2
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3PROTECTION & INDEMNITY
PROPOSAL FORM
Vessel Name: (ex)
GT/DWT
Year Built
Flag
Class
ISM/IMO
Status
Trading Area:
Date Of Last Condition
(
/
/
)
Outstanding Defects:
YES / NO
Survey:
If yes, please provide a copy of Last P&I Club
Survey
Number of Officers & Crew:
Officers:
Crew:
Nationality of Officers & Crew:
Officers:
Crew:
Limit of Liability:
Deductibles:
Crew any one accident or occurrence:
Cargo any one claim:
Constructive Total Loss:
1/4
th
R.D.C:
Additional 3/4
th
R.D.C:
All other:
Claims on Vessel in last 5 years (whether insured or not)
Year
Claim Amount
Claim Details
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