Part 1 – Your Details
Enter your Sea Start membership number
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Title
Surname
Forename(s)..
Address
Postcode
Email Address
Daytime Tel No.
Occupation (Note: ‘Director’ or other general description is not acceptable)
Sailing Experience
years as owner of the type of vessel relevant to this proposal
State other types:
Do you hold a Yacht Master’s Certificate? Yes
Have you ever had any Craft Insurance or proposal for any Craft Insurance declined or cancelled or accepted at special terms or where renewal has been refused?
Yes
Has any accident or loss occurred during the past 5 years in connection with any vessel you have owned or used?
Yes
Have you or any person having an interest in the vessel been declared bankrupt or been convicted of or received a Police caution for or been charged with but not yet tried with any offence other than driving offences? Convictions spent under the terms of Rehabilitation of Offenders Act 1974 do not need to be disclosed.
Yes
Has a third party any interest in the vessel (and such interest is to be noted in the Policy)?
Yes
State the number of years No Claims Bonus allowed at last renewal and name of Insurer:
Number of years of No Claims
Insurer
Part 2 – Particulars of Vessel
Name
Make or Model
Regd. No or Class No
Is the vessel a trimaran Yes
Material of Hull
If wood state method of construction
Dimensions (metres)
Overall length
Date of last overhaul of boat and equipment (dd/mm/yy)
Work carried out
Date built (dd/mm/yy)
By whom built
Is vessel a conversion? Yes
Is vessel amateur built? Yes
Material of delivery tubing used for bottle gas supply
sail area carried (sq metres)
Part 3 – Particulars of engine(s)
Twin or single screw
Inboard maker’s name
Year made (yyyy)
Brake Horse Power
Outboard 1 maker’s name
Year made (yyyy)
Serial No
Outboard 2 maker’s name
Year made (yyyy)
Brake Horse Power
Serial No
Type of fuel used
Max. designed speed of vessel. Over 17 knots note that Speedboat Clauses will apply and any restrictions will be advised to you with our quotation.
State number of, and types and locations of fire extinguishers carried
Part 4 – Property to be insured
** Over 17 knots note that Speedboat Clauses will apply and any restrictions will be advised to you with our quotation.
Indicate cruising limit required
Non tidal waters (including tidal waters for access to inland navigation systems)
Inland and coastal waters of Great Britain, Northern Ireland and Republic of Ireland
Inland and Coastal Waters of the United Kingdom extended to include Eire and Continental Waters La Rochelle to River Elbe
Other requirements
8. State where the vessel is normally kept during the ‘in commission’ period
If afloat – specify, mooring on river, harbour, marina etc
The vessel is laid up out of commission:
Ashore
from
and/or
Mud berth
from
and/or
Afloat on moorings
from
and/or
Afloat in marina
from
Is vessel used only for private pleasure? Yes
If NO, give details:
Indicate additional cover required:
Road Transit
Water Ski-ing Liability
Is cover required for Towing of inflatable toys?
If so, how many persons per inflatable?
Racing Risks Extension (Sail Boats only)
Please state new replacement cost of mast(s), spar(s), sails & rigging (£)
THIRD PARTY LIABILITY
Indicate Indemnity Limit Required
£1,000,000.00
Outboard & Trailer
Describe the anti-theft device(s) used to secure the outboard motor(s):
State how the trailer, if any, is immobilised when left unattended:
PART 5 – Further Disclosure
If you have not given full and accurate answers to all questions asked on this Proposal, your insurance cover may not protect you in the event of a claim. When completing this proposal you should disclose any facts which may influence the assessment and acceptance of this insurance. Failure to disclose all relevant facts may invalidate your policy or may result in the policy not operating fully.
If you need to disclose something or provide further information that has not been disclosed elsewhere on this Proposal, please use the box provided here.
Before submitting the Declaration, please read the notices on this page about the Data Protection Act.
Data Protection Act
To set up and administer your policy, we will hold and use information about you supplied by you on this form. As part of that administration, it is our duty to inform Sea Start Limited of your application. Yachtline Insurance, Nautical Insurance and/or Sea Start Limited undertake that this information will not be used for any other purpose or be supplied to a third party without your express written permission.
We will contact you by telephone, letter, fax or email, if appropriate.
Declaration
Please read the Declaration carefully.
I/We declare that the answers given to questions asked in this questionnaire are accurate and complete to the best of my/our knowledge and belief.
I/We consent to the seeking of information from other insurers to check the answers I/we have provided and I/we authorise the giving of such information for such purposes.
No cover is in force until the Proposal has been accepted by either Yachtline Insurance or Nautical Insurance.
If you prefer, please print this form, complete and post to either:
Yachtline
Nautical Insurance Services Ltd 57 Elm Road
Date (dd/mm/yy)
