Name Contact Person Insured Name Address Date of Birth Have you ever had insurance declined or special conditions imposed? Yes No Have you had any claims in the last 5 years? Yes No Have you ever been convicted of a crime or declared bankrupt? Yes No Storage Postcode How is the boat stored? Backyard / Property Boat shed Carport Securely locked compound Driveway Dry berth marina Garaged Jetty Marina Nature strip Mooring pen Pile mooring Private pontoon At rowing club Swing mooring Yacht club Racing Risk Club racing up to 25nm No racing / not applicable Ocean going racing over 200Nm Yacht racing up to 200Nm No Claim Bonus 0% 10% 15% 20% 25% Vessel Type Please select... Trailerable Powerboat (Runabout) Moored Stock Production Powerboat (Cruiser) Moored Non-Stock Production Powerboat (Cruiser) Moored Stock Production Sailboat (Yacht) Moored Non-Stock Production Sailboat (Yacht) Trailer Sailer Off Beach Sailing Multihull / Sailing Dinghy Personal Watercraft PWC (e.g. Jetski) Sailboard Houseboat High Performance Ski Boat Builders Risk Transit Vessel Description Vessel Construction Aluminium Aluminium Pontoon Carbon Fibre (Hull or Masts) Ferrocement Fibreglass / Grp Kevlar Other Plastic Rowing Craft Rubber Steel Steel Pontoon Timber Vessel length Maximum Speed Not applicable Up to 60 knots Over 60 knots Year Built Sum Insured Liability ... 5,000,000 10,000,000 20,000,000 Water Skiiers Liability Yes No Trailer Sum Insured Main Motor Sum Insured Motor Make Motor Type Inboard Jet Drive Outboard Stern Drive Fuel Type Diesel Electric Gas Outboard Mix Petrol Steam Equipment Sum Insured Masts / Spars / Sails / Rigging Sum Insured How many years have you been boating? Have you done any boating courses? Any months you are not using the boat? January February March April May June July August September October November December Additional Information Send copy to email address
