Proposal for yacht and motor boat insurance

Before completing the proposal please note that failure to disclose all material information, i.e information which is likely to influence the acceptance of the risk and terms applied, cloud invalidate the insurance. if you are in any doubt as to whether any information is material, it should be disclosed.
Name in full
Email
Age
Address
Post Code
Phone Number
Occupation / Nature of business
Names of other joint owners or Mortgagees
Detail any previous boating experience or qualifications
Have you had any accidents or losses in the past five years in connection with any craft you have sailed or owned?
YesNo
Have you or any member of your family normally residing with you, or directors where the proposer is a limited company ever been convicted of any offence other than driving offences?
YesNo
Have you or any person above suffered from diabetes, epilepsy, heart condition or any other physical or mental disability, infirmity or disease, or had any condition controlled by drugs ?
YesNo
Have you or any person above had any insurance company refused to insure you or impose any special terms ?
YesNo
About your boat

Name of craft
Manufacturer
Model / Type
Construction material
Year Built
Length & Beam
Date of acquisition
Date of last survey
Serial / HIN
Schedule of insurance

Hull / inboard engine if fitted
Outboard motors
Dinghy / tender
Road trailer / trolley
Personal effects
Special equipment
Total to be insured
Details of engine(s)

InboardOutboardSingleTwin
Make

Serial No(s)
DieselPetrolLPG
Use

Private pleasure onlyBy yourself onlyCharterRacing
Other ( Please Specify )
Maximum number of passengers carried
Are Passengers fare-paying?
YesNo
Navigating limits, select cruising range
Inland and coastal waters of the United KingdomInland and non tidal waters of the United KingdomEuropean waters brest - Elbe limitsMediterranean waters
Third party liability, Standard limit
Liability to and of water skiers select limit
Mooring Details

Location of craft when not in use
Swimming mooringFore/Aft mooringNon Tidal RiverbankCanal bankInner HarborMarinaAshoreOther

All moorings should be professionally maintained. if not please advise.

Commission Periods
Unless stated below the craft will be insured on a 12 months in commission basis

In commission fromto
Out of commission fromto
Where will craft be kept whilst out of commission
MooringsCanal BankInner HarbourSwimmingFore/AftMarina
Ashore, ( state location & security )
Sailing craft only. if racing risks required, please state new replacement value of masts spars sails & rigging
Type of racing : Local clubOffshore
It is agreed that this form shall be the basis of the contract should a policy be issued and that no information has been withheld that is necessary to the enable the underwriters to estimate the risk.
Name
Date