Reporting form concerning insurance coverage for maritime claims

Applicant's information

Applicant's nameMissing or incorrect value

Applicant's adressMissing or incorrect value

Applicant's telephone no.Missing or incorrect value

Applicant's emailEmail must comply with @ and dot (.). For example xxx@dma.dk

Ship information

Distinctive numbers or letters/Boat register no.Missing or incorrect value

After entering the callsign/distinguishing marks
move on to the next field, we will attempt
to get the ship's name and registered office.
In other case, then maybe you mistyped,
or the ship is not found in the ship register.
In this case, you will have to enter the information.

skibsregister.dma.dkFind info about your ship here

NameMissing or incorrect value

Port of registryMissing or incorrect value

IMO-numberMissing or incorrect value

Shipowner

NameMissing or incorrect value

Principal place of businessMissing or incorrect value

Insurance provider

NameMissing or incorrect value

Principal place of businessMissing or incorrect value

Insurance

TypeMissing or incorrect value

Place of business where the insurance is establishedMissing or incorrect value

DurationMissing or incorrect value

Insurance deductiblesMissing or incorrect value

Signature

Dato

PlaceMissing or incorrect value

Reporting form concerning insurance coverage for maritime claims