Please complete the following form and one of our staff members will return your enquiry:

Type of Insurance Required

Private Marine Insurance Quote

Policyholder One Full Name:
Policyholder One Date of Birth:
Policyholder One Occupation:
Policyholder Two Full Name:
Policyholder Two Date of Birth:
Policyholder Two Occupation:
Postal Address:
Telephone (Home):
Telephone (Work):
Telephone (Mobile):
Email Address:

Do you owe money on this boat?


Lenders Name & Address


Hull Details:

 
  Make
  Type
  Year of Manufacture
  Length in Metres
  Maximum Speed (knots)
  Registration Number
  Name
  Construction
  Sum Insured ($)

Engine Details:
  Make
  Serial Number
  Year of Manufacture
  Engine Size
  Fuel Type
  Inboard / Outboard
  Sum Insured ($)

Sails. Masts, Spars and Rigging Details:
  Sails are made from:
  Do you want cover for racing (sailing boats only)

Accessory Details: Includes such items as dinghies, radios, navigational aids, oars, paddles, motor covers and fire extinguishers etc. List items over $500 you want covered:
 

Sum Insured $
  Sum Insured $
  Sum Insured $
 
Total amount of all items under $500 that you want covered:		 Sum Insured $

Trailer Details:
  Registration
  Maker
  Sum Insured ($)

Previous History:

Name of Current/Previous Insurer:
Rating / No Claim Bonus:
Have you ever had insurance cancelled or declined?
Have you ever had any criminal convictions?
Have you or whoever will use the boat had their driving or boating license suspended, cancelled or restricted by endorsement in the past 5 years?
Have you or whoever will use the boat been charged with, or convicted of, or penalised, for any motoring or boating offences in the past 5 years?
If you answered yes to any of the above please enter details including year, circumstances, Insurance company and value involved :

I agree to the Terms & Conditions


 





©2006 786 Pty Ltd t/a Osman Insurance | Website by Creative Cubed | Terms & Conditions