Houseboat Policy Application Form

The Applicant/s
Cover Note Number email
Broker/Agent Tel No. Fax No.
Last Name Title
Given Name(s)
Address
Suburb State Postcode
Contact Numbers Work Home Mobile
Period of Insurance From 4.00pm To 4.00pm
Interested Parties - Finance, Bank,
Credit Union, etc (if applicable) 		Amount $
Details of the Boat & Motor(s)
HIN or Boatcode No.
  Make/Model Year Built Registration/Sail, Hull or Serial No. Hull Length
HP of Motor		 Proposed Agreed Value
Hull $
Motor 1 $
Motor 2 $
Trailer $
Name of Boat Mast, Spars, Rigging, Sails $
Date Purchased Equipment and Accessories $
Does the boat exceed
50 knots/95kph/60mph?		 No Yes Total Proposed Agreed Value $
From what type of material is your boat constructed?
Maximum Speed knots/kph
Type of Motor Inboard Outboard Sterndrive Jet
Type of Fuel Diesel Petrol Other Give Details:
Where is boat stored/moored?
How is boat stored/moored?
How has boat or motor been modified? - give details
If Yacht - type of rigging Wire Rod Date of Last Inspection Age
Number of Sails Material Age
Will the boat be used for private purposes only? Yes No
If No, please give details of use
Date boat last surveyed Please fax copy of report
What are the geographical limits in which you will be using your boat?
NB: The area your boat is used may be restricted if you are involved in yach races - refer section immediately below and also please refer to the policy booklet for full details.
Total Price Paid
What was the total price you paid for the hull, motor(s), trailer, equipment and accessories? $ 
If the total amount you paid for everything is different from the proposed agreed value you nominated, please explain why.
Yacht Races - Club Events and for Yachts only
Will you be using your boat in races organised by a Club or Association? No Yes
If Yes, do you require Yacht Racing Risks Extension cover? No Yes
NB: Race MUST be organised by a Club or Association. Also cover for Ocean going races organised by a Club or Association are limited to within 100 nautical miles of your home port or where your boat was last launched.
Liability to Third Parties
How much cover do you want for your liability to Third Parties? $5,000,000 $10,000,000
Equipment and Accessories
NB: No cover for any sporting and/or fishing equipment unless specially noted and agreed
Item Make Age Proposed Agreed Value
$
$
$
$
$
Equipment and Accessories Total $
Your Duty of Disclosure

Persons Insured

The policy will only cover the proposer(s) and no other person or persons.

Your Duty to Disclose Facts (Duty of Disclosure)

Before you enter into a contract of general insurance with an insurer, you have a duty, under the Insurance Contracts Act 1984, to disclose to the insurer every matter that you know or could be reasonably be expected to know, is relevant to the insurer's decision whether to accept the risk of the insurance and, if so, on what terms.

You have the same duty to disclose those matters to the insurer before you renew, extend, vary or reinstate a contract of general insurance.

Your duty however does not require disclosure of a matter:

  • that diminishes the risk to be undertaken by the insurer
  • that is of common knowledge
  • that your insurer knows or, in the ordinary course of his business, ought to know
  • as to which compliance with your duty is waived by the insurer.

Non-Disclosure

If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability under contract in respect of a claim or may cancel the contract.

If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning.
General Information
Have you, the proposer(s), in the past 5 years:
had any insurances cancelled, refused or had special conditions imposed No Yes
made any boast insurance claims No Yes
been charged or convicted of any offence No Yes
If the answer is Yes, to any of these questions, please give details:
Who currently insures your boat?
Is there any other information that you wish to tell us or think we should know? No Yes
If Yes, please give details:
Declaration

I/We acknowledge that as the proposer(s) I/we:

  1. must act with the utmost good faith in respect of any matter relating to this insurance
  2. have a duty of disclosure as stated in this application form
  3. have provided the correct information on previous losses and insurance history
  4. confirm that all answers and statements in this application are correct and that no information has been withheld which may affect the insurers decision to accept this application or the terms of the proposed policy.
Have you answered all the questions?

 

 

 

For more information and an obligation free quote ring
03 9670 9344