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Marine Insurance Quote

Please fill in the form below for an insurance quote.

Details of Owner

*=Required
Full Name:*
Address:*
Address:*
Address:
Postcode:*		Occupation:
Tel Home: *		Tel Mobile:
Tel Work:		Fax No:
Date of Birth:*		No of years sailing: *
E-Mail: *		Sailing qualifications: *

Details of Vessel

Boat Name:
Length: *	Feet
Builder: *
Type/Model: *
Motor/Sail
Hull Material
Year Built: *
Max Speed: *	kts
Engine
Engine Make: *
Horse Power:	hp

Details of Insurance

Boat Safety Certificate	Yes No
Price Paid £:	(Original)
Date Purchased:
Sum to be Insured £: *
No Claims Bonus:	% years
Commencement Date:	in commission
Date of Last Claim:
Value of Last Claim £:
Reason for Claim:
Last Survey Date:
Current Insurer:
Last Premium Paid £:

Navigation Limits U.K. Inland
U.K. Inland and coastal waters
Plus Eire
Plus Continental Waters Brest To Elbe
Plus Continental Waters La Rochelle To Elbe
Licened Operating Range
Other:

Moorings Moored at * Which is a
Mooring Type Other:

Ashore Kept ashore at
Locked Building Locked Compound Home Driveway

Trailers Trailer
if yes
Wheel Clamps
Outboard Enginelock
Trailer Hitch Lock

Usage Private and Pleasure Static Houseboat Live Aboard
Single Handed

Other:

Racing Racing Risks
if yes Value of masts, spars, sails and rigging £:

Ski Water Ski Liability
Towing Of Toys Other
Third Party Liability

Special Requirements

Legal Protection	Accident and Medical
Foreign Travel	Instalment Plans
Marine Finance	Recovery and Assistance
Marina Tradesmen	Loss Of Earnings
Boating Clubs	Crew Liability
Public Liability	Product Liability
Boat Sales	Boat Builders & Repairers
	Other

Please tell us how to contact you

Your Name:
Your E-Mail Address:
Your Phone Number:
Your Fax Number:

How did you find us?

Boatsandoutboards.co.uk		Boat Fishing Monthly
Practical Boat Owner		Boat Trader
Boat Mart		Catalogue
Boat and Yacht Buyer		Web Site
Sea Angler
Other