Owner full name(s)

Date of Birth

House Number and Street Address

Town or City

Postcode

Telephone

Email Address

Nationality

Number of years experience and boating qualifications

Additional owner

Owner full name(s)

Date of birth

House Number and Street Address

Town or City

Postcode

Telephone

Email Address

Nationality

Number of years experience and boating qualifications

Additional owner

Owner full name(s)

Date of birth

House Number and Street Address

Town or City

Postcode

Telephone

Email Address

Nationality

Number of years experience and boating qualifications

Additional owner

Owner full name(s)

Date of birth

House Number and Street Address

Town or City

Postcode

Telephone

Email Address

Nationality

Number of years experience and boating qualifications

Additional owner

Owner full name(s)

Date of birth

House Number and Street Address

Town or City

Postcode

Telephone

Email Address

Nationality

Number of years experience and boating qualifications

Enquiry Form Type

Boat / Vessel make and model

Boat / Vessel name

Boat / Vessel Length

Year built

Is your Boat / Vessel self-built? Yes No

Boat / Vessel material

Mast Material

Country of registration

Port or State of Registration

Registration number (if applicable)

Make of engine

HP of engine

Year of engine

Fuel type

Maximum design speed (Knots)

Please state if you are a member of any cruising associations or clubs

Rigging age (if applicable)

Year of last survey

If possible, please upload a copy of your most recent survey report here

Use Private and Pleasure Skipper Charter Bareboat Charter Commercial

Is your Boat / Vessel used for racing

Is your Boat / Vessel used for racing Yes No

If yes, please specify the type of racing you participate in and the value of mast, spars, sails and rigging

Currency

If other currency

Do you own the Vessel or is this a New Purchase Owned New Purchase

Purchase date (if applicable)

Purchase price (if applicable)

Boat / Vessel current sum insured

Add Tender(s)

Tender(s) sum insured

Add Outboard Motor(s)

Outboard motor(s) sum insured

Add Personal Effects

Personal effects sum insured

Add Other

Please specify sum insured

Total Sums Insured

Mooring Location

Type of mooring

Lay-up location (if applicable)

Lay-up dates From (if applicable)

Lay-up dates to (if applicable)

Cruising area

Other

Do you live aboard the vessel? Yes No

Please give details

Do you have a No Claims Bonus (NCB) entitlement?

Have you had any claims in the past 5 years? Yes No

Year of claim

Details of claim

Total amount paid

Add another claim

Year of claim

Details of claim

Total amount paid

Add another claim

Year of claim

Details of claim

Total amount paid

Add another claim

Year of claim

Details of claim

Total amount paid

Add another claim

Year of claim

Details of claim

Total amount paid

Finance interest

Finance company name, address and agreement number

Current Insurer

Activation Date (if known)

How did you hear about us

Where on the Internet?

Other

Any other information

Other Information

Enter promotional code (if applicable)

Please click here to read and confirm that you have read and agree to our statement and declaration

You

Have had no other insurer at any time refused to insure you, imposed special terms or requested extra precautions.
or any persons having an interest in the boat have never been convicted of arson, or of any offence involving dishonesty of any kind such as smuggling, fraud, robbery, theft or handling stolen goods.

Facts Omitted or Misrepresented
The Policy or any subsequent renewal may be deemed invalid if the insured or anyone acting on the insured’s behalf has obtained cover through omission or inaccuracy of any response provided in this Form. In the event that Insurers void the Policy a refund of premium may not be made.

DECLARATION

I/We declare that the statements and particulars contained in this form are true and complete. I/We will provide details of any alteration to this information as soon as possible prior to commencement of the period of insurance.
I/We agree that if any answers have been completed by any other person, such person shall for that purposes be regarded as my/our agent and acting on my/our behalf, and not the agent of Topsail Insurance.
I/We agree to receive the insurance quote and all other correspondence by email, to the email address provided

Aus opening hours 08.30 am to 5pm AWST ( Australian Western Standard Time) Monday to Friday.

finalCheck

Thank you for your enquiry

One of our team will get back to you at the earliest convenience.
If your enquiry is a matter of urgency then please call us on +61 8 6102 8861

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