Entry Form - Existing Charterer Clients

Entry is subject to SKULD Charteres' cover terms & conditions.

Please return the completed form duly signed.

( * must be filled in)

 

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


Double Bottom:


SBS:


Trading Information
Cargo Type:
C/P:
B/L (type, sign on behalf of)
Geographical:
Tramp/Liner Service:
Cover Information
Type:



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