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Insurance

We act as brokers for an International insurance company.

Since starting Pacific Yacht Deliveries we have had to deal with many Insurance Companies. One of these companies has stood out as being quick and easy to deal with and has consistently offered better value for money quotes than it's competitors

We are now acting as agent for this company.

Below is an insurance form for you to fill in to receive a quote.

IMPORTANT NOTICE

You must give true and full answers to all the questions as failure to disclose material facts could result in your policy being invalidated or not protecting you in the event of a claim.

Material facts are those which might influence the acceptance or assessment of your proposal. If you are in any doubt as to whether a fact is material you must disclose it.

The Company reserves the right to decline any proposal.

PARTICULARS OF PROPOSER

Surname:
Forenames:
Address:

Postcode:
E-Mail:

Telephone:
(home)
(Office)
(Mobile)
Occupation:
 (Director is not sufficient)		  DD/MM/YY
Date of Birth:
Boating Experience:
(In Years)		    In Which Craft:
Relevant Qualifications:

PARTICULARS OF VESSEL

Name:
Type or Class:
Serial No. of Hull:
Builders Name:
Year Built:
Is the vessel a conversion: YES NO
If YES was it converted by professional or amateur. Give full details of conversion and by whom, with date, below:
Length:  Beam:  Draft:  Sail Area:
Material of Hull:
Date of Last Survey:
Name of Surveyor:
Date Purchased:
Price Paid:

PARTICULARS OF ENGINES

Make & Type: Year: HP/CC: Fuel: Value Engine/Serial No.
Theft cover for outboards will not apply without serial number.
Are outboards permanently locked to transom or stored in locked premises when not in use? YES  NO
Maximum designed speed of vessel: (Knots/MPH/KPH)
If over 17 knots note the contents of the Speed Boat Clauses.
Is engine(s) fitted with an automatic or remote fire extinguishing system in the Engine Room? YES  NO
Tank Space: YES  NO Galley: YES  NO
State number and make of fire extinguishers carried:
HAND:  REMOTE:  AUTOMATIC:

GAS SYSTEM

If liquefied petroleum gas (LPG) is used is the:-
a) Cylinder kept in self draining cockpit locker: YES  NO
b) Delivery tubing copper or BS/ISO approved type: YES  NO

CRUISING RANGE

Please give full details of the cruising range undertaken or required:
Do you intend to sail single-handed?  YES  NO
Will the craft be used for:
Private and pleasure only YES  NO
Houseboat YES  NO
Hire YES  NO
Charter YES  NO
Netting/Potting YES  NO
Demonstration YES  NO
Racing YES  NO
Water Skiing YES  NO
Night Navigation YES  NO

DETAILS OF MOORINGS

Moored at:
Type of Mooring:
Period vessel in commission: Date from:To:
Period vessel laid up: Date from:To:
Laid up at: Ashore: YES  NO
Afloat:  YES  NO

SUMS TO BE INSURED
 NB. IN EUROS

Hull/Machinery/Gear/Equipment only €
Tender/Dinghy/Life raft €
Outboard Motor €
Trailer (Serial No.) €
Personal Effects (Maximum €100 any item unless specified) €
Navigation Equipment (Maximum €100 any item unless specified) €
Mast/Spars/Sails €
Other €
Total of Sums Insured €
Third Party Liability € 2,000,000  YES  NO
When do you require cover to commence:
My present policy is with:
I am earning  % No Claims Bonus for which documents for proof of this are attached.

Please send documents to Pacific Yacht Deliveries, PO Box 1803, Whangarei, 0140, New Zealand or email to yachtskipper@igrin.co.nz

DECLARATION

Have you or any person who may use this vessel with your permission ever had:-
a) Insurance on any vessel declined or Special Terms imposed YES  NO
b) Any accident or losses in respect of any vessel YES  NO
(if Yes please give details)
c) Ever been charged with or convicted of any offence involving dishonesty YES  NO
d) Is the vessel the subject of any mortgage or financial agreement YES  NO
e) Are you the sole owner of the vessel YES   NO

ADDITIONAL INFORMATION

Please enter any relevant additional information here or details of any supporting documents.

Please send documents to Pacific Yacht Deliveries, PO Box 1803, Whangarei, 0140, New Zealand or email to yachtskipper@igrin.co.nz

By clicking the "Submit Form" button below you agree to the following:

I declare that to the best of my knowledge and belief, the information given to you on this form is true in every respect. I also declare that if anything on this form was written by another person he/she acted as my agent for this purpose.

I agree that this proposal and declaration shall be the basis of the Contract between me and the Company.

Notes:

Submitting this form 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 the European Community and therefore as a non-authorised or permitted Insurer you will not be protected by any Policy Holder Protection Acts or Data Protection Acts within the European community that may apply.