Broker Pleasure Craft - Form Page

Pleasure Craft Form

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Looking for a quick quote? Please fill in the compulsory fields * and we will provide you with an indication. Please note the remainder of the form may be required to provide formal terms or cover.
Contact Details
Brokerage
Contact Person*
Email*
Phone*
Please provide
DD slash MM slash YYYY
Cover is subject to Underwriter acceptance however may commence from the date requested and submitted.
Is the Customer/You within the Target Market for this Product?
What is the maximum speed the vessel is capable of?*
It is important that our insurance policies are only sold to customers that are inside our target market.
If you answer ‘yes’ to any of the following the proposed customer is outside our target market.
Is the vessel(s) to be insured by this policy;
- not the customer’s/Your vessel (e.g. borrowed or hired)?*
- Yes
- No
- used for financial reward or vessels registered for commercial use?*
- Yes
- No
- vessels operating outside of Australian or New Zealand waters and the waters located between these 2 countries?*
- Yes
- No
- at any time during the insurance period, under construction (other than being refitted) or prior to being launched?*
- Yes
- No
- required to be registered or zoned and that are not registered as watercraft (for example, a floating office).*
- Yes
- No
- used for permanent accommodation? (agreement available upon request).*
- Yes
- No
Please consider our Target Market Determination (TMD) in full on the Documents page of our website.
The Insured
Insured Name*

Owner Title	Owner Name	D.O.B.

Are there more owners to be noted?
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email
Phone
Mobile
Interested Party

(Finance, Bank, Credit Union etc. if applicable)
%/$ Financed
Previous / Current Insurer
Expiry Date
DD slash MM slash YYYY
The Vessel
Year*
Length*
Construction*
Make & Model*
Type
Vessel Name
Reg. / Sail No.
H.I.N.

(Hull Id Number)
No. Of Hulls
Description of Build
Please provide details of modifications to the Vessel
The Motor
No. Of
Year*
HP*
Make & Model
Type*
Fuel*
Serial Number (1)
Serial Number (2)
Maximum Capable Speed*
Comment
Has the motor(s) been modified in any way?
Comment
Does the motor(s) meet the hull manufacturer's recommendations?
Comment
The Trailer
Year
Reg.
Make & Model
Sailing Vessel Only (Yachts / Catamarans)
Material/Type
Mast Rigging Sails
Type
Age
Mast Rigging Sails
Last Inspected
Mast Rigging Sails
Comment
Mast Rigging Sails
Equipment & Accessories

Item	Value

Vessel Storage
Method of Storage*
Post Code*
Location: (Marina / Address)*
Area of operation / Cruising Itinerary*
Additional Comments
Vessel Use
What will the vessel be used for?
Private Use
Timeshare Arrangement
Charter / Hire
Demonstration
Corporate Functions
Commercial Workboat
Other
Other. Please provide details:
Additional Comments
Owner's & Skipper's experience
Date this vessel was purchased
DD slash MM slash YYYY
Please provide details of previously owned vessels. Leave blank if none.

Skipper Name	Make & Model	Hull Length	Type (Power or Sail)	Length of Ownership	Area of Navigation

Please provide details of relevant licences and qualifications.

Skipper Name	Marine Licences / Qualifications	Date Obtained

Claims & Convictions
Have you, the Proposer(s), or Drivers(s) in the past 5 years:
Had any insurances cancelled, refused or had special conditions imposed?
If yes, please provide details
Made any boat insurance claims?

Date of Loss	Description of Loss	Settlement Amount

Been charged or convicted with any offence?
If yes, please provide details
Is there any other information you wish to tell us or think we should know?
If yes, please provide details
General
Has your boat been surveyed?
If yes, please provide a copy
Is the vessel, or will it be under construction or undergoing a major refit?
If yes, please provide details
Options
THIRD PARTY LEGAL LIABILITY: The quote we will provide is for Third Party Liability of $10,000,000. Do you require a different level of liability cover?
WATER SKIIERS LIABILITY: Do you require cover for water skiers liability? If water skiing cover is required on the tender, please provide details of the tender in the Equipment & Accessories section
YACHT RACING: Is the boat used for official and / or organised yacht racing?
If yes, what is the maximum distance required for any one race
NOTE: Race MUST be organised by a Club or Association. The Standard limit for Yacht Racing cover is 50nm. If you require longer nautical miles distance, please advise.
LAY-UP PERIOD (Trailer Boats Only): Do you wish to nominate a lay-up period?
If yes, Please select the months you'd like to nominate as a lay-up period
- JAN
- FEB
- MAR
- APR
- MAY
- JUN
- JUL
- AUG
- SEP
- OCT
- NOV
- DEC
Address where vessel is laid-up
Sum Insured
Purchase Price
Purchase Date
DD slash MM slash YYYY
If the total amount paid for everything is different from the agreed value nominated, please explain why.
Please note a split up of the sum insured is not compulsory. You may nominate values when an Agreed Value policy is offered.
Split up of Sum Insured
Hull & Fittings
Motor 1
Motor 2
Trailer
Equipment & Accessories (as listed above)
Masts, Spars, Rigging, Sails
TOTAL SUM INSURED*
including hull, motor(s), trailer, masts, spars, rigging, sails, equipment & accessories
Additional Comments / Information:
Email
This field is for validation purposes and should be left unchanged.

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