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6/19/2020

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Phone Number

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Membership Emails

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Raw Data Registration Structure Registration Form Text

Registration

Broker ID*

First name

Last name

Title

Phone

Home address

State

Postcode

Middle name

Broker ID*

Please Select

Policyholder*

Policy to be in name of Individual(s)

Please Select

Please SelectJerseyGuernseyAlderneySarkHermDo you have any co-owners or require joint Policyholders named on the policy?*

Yes

Please Select

Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Survey Status

Please Select

Previous NextIn Commission DetailsCommission*

12 months in commission

Vessel Mooring*Click the island to view locations...

Guernsey

Jersey

Alderney

SarkGuernsey Mooring Locations

Albert Marina

Bordeaux Harbour (swing mooring)

Beaucette Marina

Cobo East (swing mooring)

Cobo West (swing mooring)

Chouet (swing mooring)

Fort Grey (swing mooring)

Ladies Bay (swing mooring)

La Piette Hotel (swing mooring)

Le Grand Havre (swing mooring)

Le Petils (swing mooring)

Longue Hougue (swing mooring)

Marble Bay (swing mooring)

Perelle (swing mooring)

Port Grat (swing mooring)

Portlet Harbour (swing mooring)

Rousse (swing mooring)

Saints Harbour (fore and aft mooring)

Salerie Corner (swing mooring)

Salerie Harbour (swing mooring)

Saline Bay (swing mooring)

St Peter Port Harbour (fore and aft mooring)

St Peter Port Harbour (swing mooring)

St Sampsons Marina

Queen Elizabeth II Marina

Vazon (swing mooring)

Victoria Marina

On a trailor (Launch and recover only)Jersey Mooring Locations

Elizabeth Marina

St Helier Marina

La Collette Marina

St Helier Harbour (fore and aft mooring)

Old English Harbour (fore and aft mooring)

St Aubins Harbour (fore and aft mooring)

St Aubins Fort (swing mooring)

Bonne Nuit Harbour (fore and aft mooring)

Bonne Nuit harbour (swing mooring)

St Catherines Breakwater (swing mooring - deep)

Little Catherines (swing mooring - shallow)

Belcroute (swing mooring)

St Brelades (fore and aft)

St Brelades (swing)

Bouley Bay (fore and aft mooring)

Bouley Bay (swing mooring)

Gorey Harbour (swing mooring)

Green Island (swing mooring)

Rozel Harbour (fore and aft mooring)

Rozel (swing mooring)

La Rocque (fore and aft mooring)

La Rocque (swing mooring)

La Hocq (fore and aft mooring)

La Hocq (swing mooring)

On a trailor (Launch and recover only)Alderney Mooring Locations

Braye Inner Harbour (fore and aft mooring)

Braye Outer Harbour (swing mooring)

On a trailor (Launch and recover only)Sark Mooring Locations

Creux Harbour (fore and aft mooring)

Dixcart Bay (swing mooring - deep)

Greve de la Ville (swing mooring - deep)

Havre Gosseli (swing mooring - deep)

Please Select

Please selectChannel Island waters onlyChannel Island waters, adjacent French coast from Cherbourg to BrestInland and coastal waters of the United KingdomInland non-tidal waters of the United Kingdom extended to include todal accessInland and coastal waters of the United Kingdom extended to include Continental waters Brest to the River ElbeMediterranean waters not East of 5� EastMediterranean waters not East of 10� EastMediterranean waters not East of 15� EastMediterranean waters not East of 20� EastMediter

Yes

Please Select

Water skiing required?*

Yes

NoTowing of toys required?*

Yes

NoRacing risks required?*

Yes

Please enter a number greater than or equal to 0.Local club racing?*

Yes

NoOpen/Class?*

Yes

NoJunior Offshore Group/Royal Offshore Race Club?*

Yes

Please advise which use you require by ticking all the boxes which apply:*

Private and pleasure use

Skipper charter

Bare boat charter

Residential use

Commercial GU/J Reg fishing

Please Select

Please Select01234567 or moreHas any policyholder claimed on marine insurance before?*

Yes

Please Select

Please SelectRecommendationSocial MediaEmailGoogleTVRadioLocal PrintDo you currently hold any existing insurance through Islands Insurance?*

Yes

Previous NextYour quote will be based on the following assumptions about you and any other persons who you have asked to be covered, please tick the box to confirm that you have read and all policyholders do satisfy these assumptions.You and any other persons on the policy have been resident in the Channel Islands or the UK for 2 years or more.You and any other persons on the policy have no criminal convictions. We have assumed that all policyholders are conviction free � this means that within the last 5

As a policy holder, we offer a range of other insurance services. Would you like to hear about these through our marketing emails?*You can read our data protection policy, or change your preferences at any time here, or just give us a call.

Yes

Data Name	Data Type	Options
Broker ID*	Text Box
First name	Text Box
Last name	Text Box
Title	Text Box
Email	Text Box
Phone	Text Box
Home address	Text Box
State	Text Box
Postcode	Text Box
Middle name	Text Box
Broker ID*	dropdown	Please Select
	option	Policyholder*
	option	Policy to be in name of Individual(s)
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	option	Please SelectJerseyGuernseyAlderneySarkHermDo you have any co-owners or require joint Policyholders named on the policy?*
	option	Yes
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	checklist	Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Survey Status
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	number
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	dropdown	Please Select
	number
	number
	number
	number
	number
	number
	number
	number
	number
	number
	number
	number
	number
	number
	option	Previous NextIn Commission DetailsCommission*
	option	12 months in commission
	option	Vessel Mooring*Click the island to view locations...
	option	Guernsey
	option	Jersey
	option	Alderney
	checklist	SarkGuernsey Mooring Locations
	checklist	Albert Marina
	checklist	Bordeaux Harbour (swing mooring)
	checklist	Beaucette Marina
	checklist	Cobo East (swing mooring)
	checklist	Cobo West (swing mooring)
	checklist	Chouet (swing mooring)
	checklist	Fort Grey (swing mooring)
	checklist	Ladies Bay (swing mooring)
	checklist	La Piette Hotel (swing mooring)
	checklist	Le Grand Havre (swing mooring)
	checklist	Le Petils (swing mooring)
	checklist	Longue Hougue (swing mooring)
	checklist	Marble Bay (swing mooring)
	checklist	Perelle (swing mooring)
	checklist	Port Grat (swing mooring)
	checklist	Portlet Harbour (swing mooring)
	checklist	Rousse (swing mooring)
	checklist	Saints Harbour (fore and aft mooring)
	checklist	Salerie Corner (swing mooring)
	checklist	Salerie Harbour (swing mooring)
	checklist	Saline Bay (swing mooring)
	checklist	St Peter Port Harbour (fore and aft mooring)
	checklist	St Peter Port Harbour (swing mooring)
	checklist	St Sampsons Marina
	checklist	Queen Elizabeth II Marina
	checklist	Vazon (swing mooring)
	checklist	Victoria Marina
	checklist	On a trailor (Launch and recover only)Jersey Mooring Locations
	checklist	Elizabeth Marina
	checklist	St Helier Marina
	checklist	La Collette Marina
	checklist	St Helier Harbour (fore and aft mooring)
	checklist	Old English Harbour (fore and aft mooring)
	checklist	St Aubins Harbour (fore and aft mooring)
	checklist	St Aubins Fort (swing mooring)
	checklist	Bonne Nuit Harbour (fore and aft mooring)
	checklist	Bonne Nuit harbour (swing mooring)
	checklist	St Catherines Breakwater (swing mooring - deep)
	checklist	Little Catherines (swing mooring - shallow)
	checklist	Belcroute (swing mooring)
	checklist	St Brelades (fore and aft)
	checklist	St Brelades (swing)
	checklist	Bouley Bay (fore and aft mooring)
	checklist	Bouley Bay (swing mooring)
	checklist	Gorey Harbour (swing mooring)
	checklist	Green Island (swing mooring)
	checklist	Rozel Harbour (fore and aft mooring)
	checklist	Rozel (swing mooring)
	checklist	La Rocque (fore and aft mooring)
	checklist	La Rocque (swing mooring)
	checklist	La Hocq (fore and aft mooring)
	checklist	La Hocq (swing mooring)
	checklist	On a trailor (Launch and recover only)Alderney Mooring Locations
	checklist	Braye Inner Harbour (fore and aft mooring)
	checklist	Braye Outer Harbour (swing mooring)
	checklist	On a trailor (Launch and recover only)Sark Mooring Locations
	checklist	Creux Harbour (fore and aft mooring)
	checklist	Dixcart Bay (swing mooring - deep)
	checklist	Greve de la Ville (swing mooring - deep)
	checklist	Havre Gosseli (swing mooring - deep)
	dropdown	Please Select
	option	Please selectChannel Island waters onlyChannel Island waters, adjacent French coast from Cherbourg to BrestInland and coastal waters of the United KingdomInland non-tidal waters of the United Kingdom extended to include todal accessInland and coastal waters of the United Kingdom extended to include Continental waters Brest to the River ElbeMediterranean waters not East of 5� EastMediterranean waters not East of 10� EastMediterranean waters not East of 15� EastMediterranean waters not East of 20� EastMediter
	option	Yes
	dropdown	Please Select
	option	Water skiing required?*
	option	Yes
	option	NoTowing of toys required?*
	option	Yes
	option	NoRacing risks required?*
	option	Yes
	number
	option	Please enter a number greater than or equal to 0.Local club racing?*
	option	Yes
	option	NoOpen/Class?*
	option	Yes
	option	NoJunior Offshore Group/Royal Offshore Race Club?*
	option	Yes
	checklist	Please advise which use you require by ticking all the boxes which apply:*
	checklist	Private and pleasure use
	checklist	Skipper charter
	checklist	Bare boat charter
	checklist	Residential use
	checklist	Commercial GU/J Reg fishing
	dropdown	Please Select
	option	Please Select01234567 or moreHas any policyholder claimed on marine insurance before?*
	option	Yes
	dropdown	Please Select
	option	Please SelectRecommendationSocial MediaEmailGoogleTVRadioLocal PrintDo you currently hold any existing insurance through Islands Insurance?*
	option	Yes
	checklist	Previous NextYour quote will be based on the following assumptions about you and any other persons who you have asked to be covered, please tick the box to confirm that you have read and all policyholders do satisfy these assumptions.You and any other persons on the policy have been resident in the Channel Islands or the UK for 2 years or more.You and any other persons on the policy have no criminal convictions. We have assumed that all policyholders are conviction free � this means that within the last 5
	option	As a policy holder, we offer a range of other insurance services. Would you like to hear about these through our marketing emails?*You can read our data protection policy, or change your preferences at any time here, or just give us a call.
	option	Yes