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(c) Schomacker Versicherungsmakler GmbH
Hamburger Yacht-Versicherung
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Application for Charter deposit insurance
Important:
By submitting this application I confirm that I have read and understood the
Obligatory information
disclosed in compliance with § 11 VersVermV and the
Exclusive Brokerage Contract
.
The warranty certificate will be issued to you
as soon as we have received the premium
and you have returned this application to us. The warranty automatically expires at the end of that month starting after the date of the end of the charter.
Please select your premium:
Euro
Euro
Euro
Euro
Euro
Euro
Euro
incl. Dinghy
additional Premium
Deposit amount up to and including
500,-
1000,-
1500,-
2000,-
3000,-
4000,-
5000,-
Single premium
75,-
90,-
135,-
175,-
260,-
345,-
430,-
+EUR 20,-
INFORMATION CHARTERER
Surname:
First name:
Street:
Town/City:
Postcode:
E-mail:
Telephone
Mobile:
CHARTER OPERATOR DETAILS
Name:
Street:
Town/City:
Postcode:
E-mail:
(falls vorh.)
Telephone/Fax:
Name Local charter office:
Town/City:
Charter Agreement Details
Contract number:
Charter period from:
Charter period to:
Yacht type:
Shipping routes:
Charter price:
Deposit amount:
(max. Guarantee)
PAYMENT
Bank Transfer
Date of transfer:
Bank account:
Hamburger Sparkasse / Account No.1042145530 / Bank code 200 505 50
BIC: HASPDEHHXXX / IBAN: DE43 20050550 1042145530
I have read and understood the obligatory information disclosed in compliance with § 11 VersVermV, the obligatory information pursuant to § 1 VVG-Info and the Exclusive Brokerage Contract.
Right of withdrawal
The customer is entitled to withdraw his/her contractual declaration within two weeks by means of written communication, e. g. letter, fax. e-mail etc. without the requirement of stating reasons for the withdrawal. The above-mentioned time period starts no earlier than the point in time at which this instruction is received. The period for withdrawing the contractual declaration is met where the notification of withdrawal is dispatched within the specified time.
The notification of withdrawal is to be sent to:
Hamburger-Yachtversicherung / Schomacker Versicherungsmakler GmbH
Katharinenhof/Zippelhaus 2
D-20457 Hamburg/Germany
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