YACHT & MOTORBOAT INSURANCE PROPOSAL FORM Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don’t your policy may be cancelled, treated as if it never existed, or your claim rejected or not fully paid. Reference number Please write in BLOCK LETTERS and tick 3correct answer boxes. Please remember to sign the declaration at the end of the form. 1 General details 3 Details of engines Full name of owner Maximum design speed with present machinery in: Title: Mr, Mrs, Miss Date of birth knots or MPH Forenames Inboard Number of engines Surname Manufacturer Name of Main User (if different from above.) Type: Sterndrive Surface Jet IPS Shaft-drive Other (please specify) Occupation in full Year of make Nature of business Horsepower of each Fuel Full postal address Outboard Number of engines 3.1 Manufacturer Year of make Post code Horsepower Serial number Telephone daytime 3.2 Manufacturer Telephone evening Year of make Mobile Horsepower Serial number E-mail address Please note it is a policy condition that you retain a record of the Day Month Year serial number of outboard motors. Date insurance required from (The liability of the Company does not commence until this 4 Value of items to be insured proposal has been accepted by the Company and the premium paid, The insurance will automatically cover the following, provided unless otherwise agreed) the total value insured, is adequate: 1. Outboard motors up to 10 horsepower for market value provided record of serial number is kept. 2 Details of vessel to be insured 2. Ships, boats and tenders up to 16’ and valued up to £2000 provided marked with name of parent vessel. Name 3. Personal effects for 2% of value of vessel (minimum £500 maximum £2500). Class or type NOTE. Personal effects are the personal belongings of the owner and his/her family. Items that would normally be sold Length Beam Year built with the vessel in commission should not be included as personal effects but as part of the vessel value. Cover is not Material of hull available unless the vessel has lockable cabin accommodation. Name of builder If the items listed by you fall within these limits they will not be shown separately in the schedule. There is no need to advise the Actual price paid £ Date Company of alterations within these limits. If vessel registered, please state where Value of vessel and accessories £ Date of last survey Market value of each outboard motor £ Surveyor’s name Market value of trolley £ Is the vessel of amateur construction/fitout? Yes No Ships boats and tenders £ Has the vessel been converted/modified? Yes No If design speed of above exceeds 17 knots Please tick If Yes, please give details Value of trailer £ Personal effects £ Total value to be insured £ State number type, make and location of fire extinguishers Please list personal effects worth over £200 per item £ £ £ £ 5 Additional Cover 8 Cruising Range Do you wish to cover any of the following additional risks? Please indicate required cruising limits. If ‘D’ state precise requirements (a) If over 30 feet overall, accidental loss or damage to the insured A Non-tidal waters of the United Kingdom but including vessel while in transit by road inter-connecting tidal stretches for direct access to within the United Kingdom? Yes No inland navigation systems A (b) Liability to or of persons towed on B Inland and coastal waters of the United Kingdom waterskis by the insured vessel Yes No excluding Channel Islands, Isle of Man and Northern Ireland B (c) Legal protection cover Yes No C United Kingdom, Eire, Continent of Europe, that is between Brest and the River Elbe including Channel Islands, Isle of Man and Northern Ireland C 6 Use D Elsewhere, please state below D Will the vessel be used for any purpose other then your own private pleasure? Yes No If YES, please give details Is the vessel used for long term residential purposes by any persons? Yes No 9 Experience If YES, please give details Please give details of the main users experience in charge of a similar size and type of craft. Will the vessel be used for racing? Yes No If YES please indicate type of event entered: Local club racing in UK Coastal Waters Other events e.g. Solent Series (Hamble), Cowes or Cork Week Number of years R.O.R.C., J.O.G. or one design Please give details of any relevant qualifications you hold. Do you wish to cover racing risks to masts spars and sails? Yes No If YES please state total value of masts spars and sails etc. £ Note: This value should represent the total replacement cost as new of masts, spars, (including fittings attached thereto) standing and running rigging plus the total replacement cost as new of the maximum number of sails that can be set at one time. If a professional skipper is employed please give name and attach (We recommend a minimum of 20% value of vessel.) copy of their current CV. 7 Mooring location Please state location of the vessel’s permanent moorings when in commission 10 Claims experience Have any accidents or losses occurred in the past Marina berth? Yes No 5 years in connection with any vessel owned or sailed by anyone named in this form or your professional skipper? Is the vessel to be Laid Up? Yes No If YES, then please state location Please answer Yes No If YES please give date and amount of each accident or loss Date Amount Details and whether Ashore Afloat on moorings or afloat in dock Laid up period to be (state months and days inclusive) from to or throughout the period of Insurance 11 Finance interest 13 General questions (please answer all the Does any finance company have an interest questions below) in the vessel to be insured? Yes No Has any other Insurer at any time refused If YES, please give name, address and agreement number to insure you or anyone named in this form, imposed special terms or requested extra precautions? Yes No Have you or anyone named on this form been convicted of, or received a police caution, for any criminal offence (other than motoring offences) which are not spent and/or are there any prosecutions pending for non motoring offences. Yes No If the policy is in a company name or the vessel is used commercially in any way please 12 Previous Insurance Details confirm if there is any other material Name of present or previous insurer information you should disclose? Yes No Material information includes any unusual or special circumstances Renewal date if known which increases the risk or any particular concerns which led to the No claims bonus awarded years insurance being placed. (if applicable please enclose latest renewal notice as proof) If the answer is Yes to any of the above please give full details. Information you should provide Important Notes & Declaration You must tell us immediately if at any time any of the information In selecting insurance for your craft, you have chosen a level of on which this insurance is based is incorrect or changes for example cover from a range of Navigators & General products in accordance if you change your vessel, permanent mooring or usage or anyone covered by this policy is convicted of an offence. Failure to do so with your requirements. Whilst making this decision, you have not may result in your insurance no longer being valid and claims not received a personal recommendation from Zurich Insurance plc. Your being met or claims not being met in full. If in doubt about any cover is shown on your schedule. change, please let us know. The changes, if accepted by us, will apply from the date indicated on your updated schedule. In this case we Cancellation rights will be entitled to vary the premium and terms for the rest of the If you decide that you do not want to accept the policy (or any period of insurance. You should keep a record including copies of all subsequent renewal of the policy by us), please return the Certificate communication of all information supplied to us in connection with of Insurance to us (or your insurance advisor) using the contact details this insurance. provided on the covering letter within 14 days of receiving it (or for renewals, within 14 days of your policy renewal date). We will only How we use your information charge you on a pro rata basis for the time we have been on cover Zurich Insurance plc holds your personal information in accordance subject to a minimum premium of £50 (plus insurance premium tax). with the Data Protection Act 1998. The information supplied to us The balance of the premium will be returned to you. If you cancel your by you may be held on computer and passed to other insurers and policy later than 14 days from receiving it we will give you a refund re-insurers for underwriting and claims purposes. You should show in proportion to the time left until your current period of insurance is this notice to anyone whose personal information may be processed due to run out, subject to a minimum premium of £50 (plus insurance to administer this policy, including handling any claims. premium tax). Please note that no cancellation refund will be allowed if a Total Loss claim settlement has been paid or is in negotiation. We use a variety of security technologies and procedures to help protect your information from inappropriate use, and we will Governing Law/Communication language continue to revise procedures and implement additional security features as new technology becomes available.