Marine Hull Declaration Form

This is an electronic Claim Form that you can fill in case you have to report any loss or damage to your insured vessel covered under Victoire's Marine Hull policy.

You can declare the event either by telephone or by fax, but it is still necessary to fill in a Claim Form and some needed documents are necessary to be submitted to the Claims Department thus complying with required rules.

For this reason, we are providing you with the electronic form to be duly filled-in and the list of requirements which should be sent to us by hand the soonest thus allowing the claims department resolve the claim the soonest.

Necessary Documents that should be submitted to the Claims Department

• Official Police Report
• Port Authority Report (if accident occurs within the boundaries)
• Original Policy
• Marine Expert Report
• Registration Official Papers

PS: Fields marked with a (*) are required.
Policy Holder *
Insured Name
Address
E-mail *
Phone Number
Policy Number *
Type of Cover	All Risks Cover Third Party Liability
Name of Vessel
Date of Accident	dd/MM/yy
Was There any Expert Report	Yes No
Expert Name
Brief Description of Accident
Brief Description of Losses and Occurring Damage (Own and Third Party)
Estimation of Own Losses
Estimation of Third Party Losses

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