Is vessel a conversion Yes No

Are outboards permanently locked to transom or stored in locked premises when not in use? Yes No

(If over 17 Knots please note the contents of the speed boat clauses)

Are the following areas fitted with an automatic or remote fire extinguishing system?

Engine Yes No

Tank Space Yes No

Galley Yes No

State number and make of fire extinguishers carried:

Is liquefied petroleum gas (LPG) is used Yes No

Is the vessel laid up ashore or afloat Ashore Afloat

What cover do you require (Please select) Fully Comprehensive Third Party

Do you intend to sail single handed? Yes No

Cover required for private and pleasure only Yes No

Is the vessel your main residence? Yes No

Cover required for hire/charter/commercial Yes No

Cover required for Wreck Removal, Salvage and Disposal Yes No

Cover required for racing Yes No

Cover required for Water Skiing Yes No

Cover required for Windstorms (Beaufort Scale) 12+ 7-12 None

Cover required for Night Navigation Yes No

Agreed Value Yes No

(If yes, this will be subject to an up to date valuation survey and photographs)

Is the vessel currently insured Yes No

Plesae enter whole numbers only, no commas or decimals
(e.g. for £8,945.15, please enter 8945), or a 0 (zero) if not required.

The following section must be completed

It is understood and agreed that in the event of a Severe Storm warning, I/We will make every reasonable effort to safeguard the vessel and/or its equipment, including but not limited to removing/stowing of sails, bimini cover, loose items, outriggers and antennas (Please tick)

Have you ever had Insurance on any vessel declined or Special Terms imposed? Yes No

Have you ever had any accident or losses in respect of any vessel? Yes No

Have you ever been charged with or convicted of any offence involving dishonesty? Yes No

Are you the sole owner of the vessel? Yes No

Is the vessel the subject of any mortgage or financial agreement? Yes No

I hereby declare that all the information I have given on the proposal form is correct at the time of signing and that I understand I would be obliged to inform insurers of any changes that occur during the policy period and that failure to do so could invalidate this contract of insurance. I also declare that if anything on this form was written by another person he/she acted as my agent for this purpose.
Clicking below does not bind the proposer to complete this insurance. The Company reserves the right to decline any proposal. The Proposer should keep a record of all information supplied to the Insurer for the purpose of entering into the Contract, and a copy of this Proposal will be supplied on request, within a period of three months after completion.
This insurance contract will be placed with an Insurer located and registered outside your place of domicile and/or agreed geographical area of operation/use and therefore as a non-authorised or regulated Insurer you will not be protected by any policyholder protection or data protection acts that may apply. (Please tick)

Please confirm you have read and accept the policy clauses (Please tick)