Skuld - Mobile Offshore Unit (MOU) Declaration Form

Mobile Offshore Unit (MOU) Declaration Form

Please insert details requested below in the empty boxes in order for SKULD to process relevant insurance documentation as expedite as possible. The completed form will be sent automaticly to SKULD's offshore syndicate on the following email address: offshore@skuld.com - thank you.

Section 1 - Assured Information

Please provide details of all parties, affiliates and co-assureds who are to be listed in certificate of insurance, as well as details of any interested parties who need to be noted, as well as details of any mortagagee bank etc:

Assured
Name:
Address:
Function / Capacity:
Contact:
Phone:
E-mail:

Registered Owner of the Unit/Vessel (if other than the Assured)
Name:
Address:

Co-Assured(s)	Name	Function







Other interested Parties (e.g.Affiliate, Technical Manager, Mortgagee Bank etc)	Name	Function








Notes to Section 1

Section 2 - Unit/Vessel Information
Name of Unit/Vessel:
Type of Unit/Vessel
Age/Original Year of Build:
Modified:
GT:
Classification Society:
Class Notation:
If with existing Classification Society less than 3 years, please advise who previous Classification Society was:
IMO Number:
Call Sign:
Flag:
Port of registry:
Effective date of cover / entry:

Notes to Section 2

Section 3 - Underwriting Information

A. Skuld's Terms and Conditions for Offshore - MOU P&I Cover (Section A, Part 1)

Limit(s) of P&I Cover required:
Please specify deductible(s) required:
Exclusions of cover (please make ref to relevant clauses):

B. Skuld's Terms and Conditions for Offshore - Additional Cover (section A, Part 2 and Section B)

Section A, Part 2

Cover	Limit required	Deductible required
Collision (RDC)
Contact (FFO)
War Risks

Section B

Cover	Limit required	Deductible required
Extended Contractual Liability (ECL) (PART 1)
Property and Personnel (PART 6)
Pollution caused by blow out etc. (PART 7)
Clean up costs (PART 8)

	Note: The maximum limit of indemnity/cover afforded under Section B PARTS 1, 6 and 8 is MUSD25 any one unit any one event. The maximum limit of indemnity/cover afforded under Section B PART 7 is MUSD5.

C. Inspections/Classification

Has the unit been inspected in the past year for or on behalf of an independent party? (If yes - please provide a copy of the inspection report and subsequent follow up/exchanges.)

Does the Unit have any existing conditions of Class?

For whom (which client/operator/company) is the Unit currently working?

Please provide details regarding length of contract/area of operation (mid to long term contracts need only be specfied)

D. Other insurances

Please provide details of the lead insurers for Hull and Machinery:

Please confirm the Unit's insured value:

Please confirm with whom the unit is insured for primary war risks:

E. Crew details (employed by the Assured)


Number of crew	Crew function	Crew nationality







Specifications of other person employed by the Assured to perform service on board the Unit:

	Note: Crew contracts must be approved by SKULD in order for the Assured to make insurance claim against SKULD for liability that may arise under the crew contract.


F. Additional information

Please provide any notes to section 3 or any additional information that you believe should be submitted to Skuld in consideration of this Risk: