Hamburger Yacht-Versicherung
Schomacker

Phone: +4940 369849-0
Fax: +4940 369849-11

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Application for travel cancellation insurance incl. insurance against insolvency

Important:

By transferring the premium I acknowledge that I have read and understood the

Obligatory information disclosed in compliance with § 11 VersVermV, the

Exclusive Brokerage Contract and the

obligatory information pursuant to § 1 VVG-Info.

Insurance covering the costs of travel cancellation or insurance against insolvency of the travel agency/ charter operator must be arranged no later than 14 days after the travel booking is made. If there are less than 30 days between the booking and the time of travel, the insurance must be arranged concurrently with the booking. The full scope of the policy is based on the General Terms and Conditions for Travel Cancellation Insurance (ABRV) and the Insolvency clause.

Please choose your payment method:

Please simply download the remittance slip , complete it and transfer payment.

oder

Please send the remittance slip to me:

oder

	Surname :		First name:
	Street:		Postcode:
	City/Town:

Payment via PayPal account or credit card:
Please select	Travel price/ Charter fee (in EURO)	Premium
	up to 1000,-	55,- EURO
	over 1000,- up to 1500,-	83,- EURO
	over 1500,- up to 2000,-	102,- EURO
	over 2000,- up to 3000,-	147,- EURO
	over 3000,- up to 4000,-	190,- EURO
	over 4000,- up to 5000,-	230,- EURO
	over 5000,- up to 6000,-	268,- EURO
	over 6000,- up to 8000,-	355,- EURO
	over 8000,- up to 10000,-	440,- EURO
The stated premiums include statutory insurance tax and charges.
Important: The full cost of travel must always be insured. Where the Charterer only insures the sum of EUR 1,000.00 but the cost of travel is EUR 1,050.00, the insurance will be null and void. The aforementioned premiums apply for up to 8 people. 9-12 persons can be insured on request for one sailing trip.

Charterer Information
Surname:		First name:
Street:		Town/City:
Postcode:		E-mail:
Telephone		Mobile:

Charter Operator Detail
Name Company/Agency:		Telephon and Fax:
Local charter office:		Charter office Street:
Charter office Town/ City:		Charter office Telephon:

Charter Agreement Details
Agreement date:		Contract number:
Charter period from:		Charter period to:
Yacht type:
When did you transfer the charter fee
When was the remainder paid:
Crewmember:
Name Skipper:		Year of birth:
Name Person 2:		Year of birth:
Name Person 3:		Year of birth:
Name Person 4:		Year of birth:
Name Person 5:		Year of birth:
Name Person 6:		Year of birth:
Name Person 7:		Year of birth:
Name Person 8:		Year of birth:

Payment
Bank transfer:		Date of transfer:
Bank account: Hamburger Sparkasse / Account No.1042216786 / Bank code 200 505 50 BIC: HASPDEHHXXX / IBAN: DE29 20050550 1042216786
		Your online handling fee: Euro
Please click if you pay by credit card (or a PayPal account) from an EU country or Norway, Iceland and Lichtenstein. This will reduce your online handling fee.
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

Hamburger Yacht-Versicherung Schomacker

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Hamburger Yacht-Versicherung
Schomacker