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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
***select***
Quote by:
Cover from:
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?
*
***select***
Up to 40knots / 75km/hour
40-60knots / 75-110km/hour
Over 60knots / 110km/hour
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?
No
Yes
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
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
***select***
Catamaran POWER
Catamaran SAILING
Flybridge / Sports Cruiser
Half Cabin Cruiser
Houseboat
Jet Boat
P.W.C. (Jet Ski)
Mono Hull MOTOR Yacht
Mono Hull SAILING Yacht
Pontoon / BBQ Boat
Rigid Inflatable
Runabout
Sailing Dinghy / Skiff
Ski Boat
Trimaran
Other
Vessel Name
Reg. / Sail No.
H.I.N.
(Hull Id Number)
No. Of Hulls
Description of Build
***select***
Stock Production
Professional Custom Build
Owner Built
Kit Built
Please provide details of modifications to the Vessel
The Motor
No. Of
Year
*
HP
*
Make & Model
Type
*
***select***
Inboard
Outboard
Sterndrive
Jet
Sail drive
Other
Fuel
*
***select***
Petrol
Diesel
Electric
Other
Serial Number (1)
Serial Number (2)
Maximum Capable Speed
*
***select***
Up to 40knots / 75km/hour
40-60knots / 75-110km/hour
Over 60knots / 110km/hour
Comment
Has the motor(s) been modified in any way?
***select***
Yes
No
Comment
Does the motor(s) meet the hull manufacturer's recommendations?
***select***
Yes
No
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
*
***select***
TRAILER - Garage / Shed
TRAILER - Roadside / Carport / Other
HARDSTAND / RACK
MARINA BERTH
PRIVATE JETTY
FORE & AFT MOORING
SWING MOORING
OTHER
Post Code
*
Location: (Marina / Address)
*
Area of operation / Cruising Itinerary
*
Additional Comments
Vessel Use
What will the vessel be used for?
Private Use
***select***
Yes
No
Maybe
Timeshare Arrangement
***select***
Yes
No
Maybe
Charter / Hire
***select***
Yes
No
Maybe
Demonstration
***select***
Yes
No
Maybe
Corporate Functions
***select***
Yes
No
Maybe
Commercial Workboat
***select***
Yes
No
Maybe
Other
***select***
Yes
No
Maybe
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?
***select***
Yes
No
Subject to No
Subject to Nil
If yes, please provide details
Made any boat insurance claims?
***select***
Yes
No
Subject to No
Subject to Nil
Date of Loss
Description of Loss
Settlement Amount
Been charged or convicted with any offence?
***select***
Yes
No
Subject to No
Subject to Nil
If yes, please provide details
Is there any other information you wish to tell us or think we should know?
***select***
Yes
No
Subject to No
Subject to Nil
If yes, please provide details
General
Has your boat been surveyed?
***select***
Yes
No
If yes, please provide a copy
Is the vessel, or will it be under construction or undergoing a major refit?
***select***
Yes
No
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?
Yes
No
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
***select***
No
Yes on this boat
Yes on the tender for this boat
Please quote with and without
YACHT RACING: Is the boat used for official and / or organised yacht racing?
***select***
Yes
No
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?
***select***
Yes
No
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:
Phone
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Email
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Comments
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