Entry Form - Existing Owner Members

 

Entry is subject to the Statutes and Rules of Assuranceforeningen SKULD and to terms and conditions separately agreed upon.

We would like to draw your attention to Rule 1, 4 and 45 which define Members, Joint Members, Co-Assureds, Affiliates and Fleet entries.  Joint Members and Co-Assureds shall be jointly and severally liable in respect of all premiums, calls and other sums due to the Association. Members or Joint Members named in the Certificate of Entry for one or more ships forming part of a Fleet entry shall be jointly and severally liable in respect of premiums, calls and other sums due to the Association for any or all vessels in the fleet.

Please return the completed form duly signed.

MEMBER INFORMATION: (Upon request we can register as Member the Managing Owner, Registered Owner and other companies within the Member Group.)

( * must be filled in)

 

Managing Owner:
Name:*
Address:
Post Code:
City:
Country:
Phone:
Fax:
VAT No:
Reg. Owner:
Name:
Address:
Post Code:
City:
Country:
E-mail:
VAT No:
Other Member
Name:
Role:
Address:
Post Code:
City:
Country:
Phone:
Fax:
E-mail:
Name:
Role:
Address:
Post Code:
City:
Country:
Phone:
Fax:
E-mail:
Co-assured Information
Name:
Role:
Address:
Phone:
Post Code:
Fax:
City:
Country:
E-mail:
Name:
Address:
Post Code:
City:
Country:
Role:
Phone:
Fax:
E-mail:
Vessel Information
Vessel Name:*
Class:
IMO No.:
Type:
Port of Reg.:
GT:*
Call Sign:
Flag:*
Year Built:*
Double Hull:


Double Bottom:


SBT:


Any changes in Class in the last 3 years?


If YES, when ?
Has the vessel undergone previous P&I condition survey?


If YES, when ?
Crew Information
Rank:
Nationality:
Contract:
Number:
Trading Information
C/P:
Geographical:
Tramp/Liner Service:
Cover Information
Cover type:



Entry Date:
Others (please select):
Date:
Signature:
Additional Information:
Choose Skuld Syndicate
Your E-mail Address:*