Pleasure craft insurance application
1. Insured(s) Details
Insured(s) Full Name*
Phone Number*
Date Of Birth*
Email*
Postal Address*
Boat Licence No
Boating Experience/Qualifications*
Interested Parties
Number of years boating experience*
Are you registered for GST?
Yes
No
Has the insured(s) been convicted of any offence in the last five years?*
Yes
No
Has the insured(s) ever had and insurance refused or cancelled?*
Yes
No
Has the insured(s) had any boat, theft or malicious damage claims in the last 5 years?*
Yes
No
Details of previous boats owned by the insured including length, type, & period of ownership*
2. Risk Details
Use of Vessel*
Private
Hire
Charter
Demonstration
Stock Afloat
Other
Boat Name
Is this vessel your permanent home?
Yes
No
Has the vessel been professionally built*
Yes
No
3. Hull
Vessel Type*
Power Catamaran
Sailing Monohull Yacht
Sailing Catamaran
PWC/Jet Ski
Trailable motorboat
Motor cruiser
Trailer Sailer
Dinghy/Off-beach
Other
Make*
Model*
Construction*
Year*
Length*
Rego*
HIN
State/Country of Registration
4. Motor/s
Motor 1
Type of Motor
Inboard
Outboard
Stern Drive
Jet
Make
Year
Model
Power HP
Serial Number
Turbo Charged
Yes
No
Fuel
Diesel
Petrol
Gas
Electric
Motor 2
Make
Year
Power
Serial No.
Turbo Charged
Yes
No
Fuel
Diesel
Petrol
Gas
Electric
5. Tender / Trailer
Tender
Make
Year
Length
Engine
Horsepower
Serial Number
Fuel
Diesel
Petrol
Gas
Electric
Does the tender hold independent registration?*
Yes
No
Trailer
Make
Year
Length
Registration No
6. Mast, Spars, Rigging (Sailing Yachts Only)
Type of Rig
Masthead
Fractional
Rigging Material
Stainless Steel Wire
Rod
Dyneema
Other
Type of Spreaders
Inline
Sweptback
Number of Spreaders
Age of Rigging
Mast Contruction
Aluminium
Carbon
Wood
Fibreglass
Aluminium & Carbon
7. Coverage Details
Total Sum Insured *
Legal Liability Required*
$10,000,000
$20,000,000
Do you require water skiing liability cover*
Yes
No
Is the sailboat used for official and/or organised races and/or speed trials?*
Yes
No
Maximum Distance for one race
50nm
100nm
100nm+
Are spinnakers used?
Yes
No
8. Mooring
Mooring/Storage Location*
Is the Mooring Professionally Installed & Maintained
Yes
No
Type of Mooring*
Marina Berth
Swing Mooring
Dry Stack
Trailer
Private Pontoon
Hardstand
Other
9. General
Type of Fire Extinguisher*
Automatic
Manual
None
Maximum Speed of Vessel*
Select
Under 20 knots
Under 60 knots
Over 60 knots
Who is your current insurer?
Due date for renewal?
Date purchased
Date of last condition report
(MM/YYYY)
Is Lay Up Cover required
Yes
No
Has your vessel's hull or motor/s been modified or performance enhanced in any way*
Yes
No
Price Vessel was purchased for
Cruising range / area of operation*
Has the vessel been for sale in the past 12 months
Yes
No
Have you had the vessel uninsured in the past 12 months*
Yes
No
10. Terms
Please attach all supporting documents required:
1. Condition Report
2. Valuation
3. Rig Report
4. Photographs
If you have any of the following documents please email them to
enquiries@topsailinsurance.com.au
Additional Information
Declaration
I/We declare that: a) To the best of my/our knowledge and belief the information provided herein is true and correct in every respect and
I/we have not withheld any relevant information.*
Thank you! Your submission has been received!
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