email:        Name:

Date of Birth: ^(dd/mm/yyyy)

      Address:  

   Post Code:

    Telephone: Fax

  Occupation:     Business:

Renewal Date of Existing Policy:

Make and Model of Boat:     Builder   

Hull Material nbsp;      

Length  Beam  Age  Max Speed

Boating Experience

Year of manufacture:       (YYYY) Date Purchased:    (YYYY)   

Price Paid       £

SUMS INSURED

Current Value and sums insured:   Hull:  £

                                                Dinghy:  £    OBM: £ 

                                                Trailer £    

Personal effects: £      S Equip £  Life Raft £  

Cruising Please Specify:   Inland Non Tidal Inl. & 30 days Coastal Inland & Coastal UK - Brest/Elbe UK - Elbe/La Rochelle N.E. 10 Deg E/N.S 48 Deg N Other    

If Other please specify    

Months Moored I/C       Moored at:

Laid Up from   To:  Laid up at      

Ashore/Afloat Ashore Afloat

Boat use: Please specify:         Cruising Racing Risk Extention

Has the craft been modified?   Yes No

If so please give details:      

Do you require cover for Road Transit ? Yes No

Do you require cover for liability to / of water-skiers/towed objects? Yes No

Limit in respect of Legal Liability   £500,000 £1,000,000 £2,000,000

Will the boat be used for Commercial Use - if so please state usage

If used commercially please advise Gross Tonnage and number of passengers carried

Serial Numbers

                        Hull:  

                    Engine:  

  Data Tag Number:  

Marina Storage Address:  

Have you had any claims in the last five years:    No Yes

If so please give details:  

Have you ever been convicted of any criminal offence:   Yes No

Please give details     

Have any insurer refused or declined cover:     No Yes

If so please advise details    

Quotation will be e-mailed

Thank You