For Charter Vessel Quotes, please contact the office directly on 0800 360 1010.
Broker/Client Details
Broker: Your Email Address:
Client: DOB: dd/mm/yyyy
       
Vessel Details
Vessel's Name: Type:
Make/Model: Construction:
Length: Year Built:
Use:  Private    
Engine: Fuel:
Hp: Maximum Speed:
Mooring Type: Area:
Mooring Location: Drystack: Yes No
Trailercraft Location:
Type of Trailer security device fitted:
Details of security devices fitted:
 
Insurance Details
Sum Insured $ Yacht Racing Risk: Yes No
  Type:
Excess: $250 $500 $1000
Boating Experience: Years Qualifications:
Previous Boat Claims: Current Insurer:
I am a: Broker
Non Broker
       
When completed press 'Send Form', or print and fax to (09 3601017)