Topsail Marine Insurance

Application Form for Tall Ships Bronze Travel Policy

Please fill in the form below. Payment can be made online through our secure payment system.

Your Details

First Name
Surname
Date of Birth (DD/MM/YYYY)
Home Address
City/Town
Postcode
Telephone
Email Address
Confirm Email Address (why?)

Residential Information

Are you habitually resident in the United Kingdom?
(Do you have a permanent place of residence in the UK)		 Yes
No
Are you participating in any round the world race (either partly or wholly)? Yes
No

Period of Insurance

Cover to commence on:
  • Please note that cancellation sections of the policy only come into effect from the date of commencement of the insurance
  • Note: Tall Ships Bronze allows for up to 45 days away from the UK at any one time. If longer duration than 30 days required please use Tall Ships Gold (60 days plus) or Tall Ships Silver (45 days)

Other Persons to be Insured

Other Person 1
Spouse/Partner?
First Name
Surname
Date of Birth

Other Person 2

  
First Name
Surname
Date of Birth

Other Person 3

  
First Name
Surname
Date of Birth

Other Person 4

  
First Name
Surname
Date of Birth
   

Other Information

You do not have to advise us of medical conditions unless you or any person on whose health the trip may depend, whose condition may give rise to a claim has during the two years prior to the commencement of cover under this Policy received or been referred for any treatment surgery, investigations or follow-ups at any hospital, surgery or clinic any of the following medical conditions:

Asthma requiring inpatient treatment, bronchitis, any other lung or respiratory condition, cancer, any growth or form of malignancy, diabetes mellitus, epilepsy or fits, any kidney or bladder disorder, any mental or psychological condition;

or
has any other medical condition that is ongoing or from which you have suffered symptoms requiring inpatient treatment during the two years prior to the commencement of cover under this Policy and/or any Trip;

or
has ever had cardiovascular problems, or other heart condition, hypertension or any cerebrovascular problems that had occurred at anytime prior to the commencement of cover under this Policy and/or prior to any Trip.

Do you have any medical declaration to make? Yes
No
Are you eligible for the Family Discount? Yes
No
  • Both parents and all dependant children/young people aged 18 or under and in full time education
Agent Code (if allocated):

Important Notice: Please read the following

You may find it helpful to keep an independent record of the information you supply in connection with your proposal, including copies of any relevant letters.
A copy of your completed Proposal Form is available from your Insurance Broker on request within three months of completion. Any enquiry or complaint concerning this Insurance should in the first instance be addressed to your Insurance Broker.
If you are not satisfied with the manner in which your complaint has been dealt, you may ask the Complaints Department at Lloyd's of London to review your case without prejudice to your rights in law.
The address is: Complaints Department, Lloyd's of London, One Lime Street, London, EC3M 7HA. Telephone (020) 7327 5693.

Cooling Off period:
If within 14 days of accepting this insurance, you discover that it is unsuitable, your unused premium will be refunded to you at short-term rates, provided that you have not made a claim.

I consent to the Underwriters seeking medical information concerning anything that affects my physical or mental health and seeking any information from any Insurance Office to which a proposal has been made for insurance on my life and I authorise the giving of such information.
I hereby consent to any information you may have about me being processed by you for the purposes of providing insurance and claims handling, which may necessitate your providing such information to third parties.

This insurance excludes trips booked or commenced against medical advice or after receipt of a terminal prognosis or for the purpose of obtaining medical treatment or convalescent care. It also excludes claims for medical conditions or other circumstances known to the Insured Person at the time that the trip was booked or the insurance was effected whichever was the later. If at any time you are in doubt about the relevance of these or any other exclusions mentioned herein, clarification should be sought from underwriters.