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Commercial Hull Form
Online Quote
Looking for a quick quote? Please fill in the compulsory fields
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and we will provide you with an indication. Please note the remainder of the form may be required to provide formal terms or cover.
Brokerage
Brokerage
Contact Person
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Email
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Please provide
***select***
Quote by:
Cover from:
Cover is subject to Underwriter acceptance however may commence from the date requested and submitted.
The Insured
Insured Name
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Owner Title
Owner Name
D.O.B.
Are there more owners to be noted?
No
Yes
Street Address
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Email
Phone
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Interested Party
(Finance, Bank, Credit Union etc. if applicable)
%/$ Financed
Registered for GST?
Yes
No
Third Choice
Percentage of Business Taxable
ABN
Previous / Current Insurer
Expiry Date
The Vessel
Year
*
Length
*
Construction
*
Make & Model
*
Type
***select***
Catamaran POWER
Catamaran SAILING
Flybridge / Sports Cruiser
Half Cabin Cruiser
Houseboat
Jet Boat
P.W.C. (Jet Ski)
Mono Hull MOTOR Yacht
Mono Hull SAILING Yacht
Pontoon / BBQ Boat
Rigid Inflatable
Runabout
Sailing Dinghy / Skiff
Ski Boat
Trimaran
Other
Vessel Name
Reg. / Sail No.
H.I.N.
(Hull Id Number)
No. Of Hulls
Tonnage
Description of Build
***select***
Stock Production
Professional Custom Build
Owner Built
Kit Built
Please provide details of modifications to the Vessel
The Motor
No. Of
Year
*
HP
*
Make & Model
Type
*
***select***
Inboard
Outboard
Sterndrive
Jet
Sail drive
Other
Fuel
*
***select***
Petrol
Diesel
Electric
Other
Serial Number (1)
Serial Number (2)
Maximum Capable Speed
*
***select***
Up to 40knots / 75km/hour
40-60knots / 75-110km/hour
Over 60knots / 110km/hour
Comment
Has the motor(s) been modified in any way?
***select***
Yes
No
Comment
Does the motor(s) meet the hull manufacturer's recommendations?
***select***
Yes
No
Comment
The Trailer
Year
Reg.
Make & Model
Equipment & Accessories
Item
Value
Sailing Vessel Only (Yachts / Catamarans)
Material/Type
Mast
***select***
Aluminium
Carbon
Wood
Fibreglass
Aluminium & Carbon
Other
Rigging
***select***
Rod Rigged
Wire, stainless steel
Other
Sails
Type
***select***
Masthead
Fractional
Age
Mast
Rigging
Sails
Last Inspected
Mast
Rigging
Sails
Comment
Mast
Rigging
Sails
Vessel Storage / Area of Operation
Method of Storage
*
***select***
TRAILER - Garage / Shed
TRAILER - Roadside / Carport / Other
HARDSTAND / RACK
MARINA BERTH
PRIVATE JETTY
FORE & AFT MOORING
SWING MOORING
OTHER
Post Code
*
Location: (Marina / Address)
*
Area of operation / Cruising Itinerary
*
Additional Comments
Vessel Use
Please describe fully the use of the vessel
*
Survey Class
*
***select***
Not applicable
Class 1 - Passenger vessels carrying more than 12 passengers
Class 2 - Trading vessels carrying up to 12 passengers
Class 3 - Fishing vessles
Class 1F - Hire and drive vessels
***select***
Not applicable
A - Unlimited area of operation
B - Offshore operations to 200 miles off the coast
C - Restricted offshore operations within a range of 30 miles from sheltered waters or safe haven
D - Operations within declared partially smooth waters
E - Operations within declared smooth waters
***select***
Not applicable
Class 1 - Passenger vessels carrying more than 12 passengers
Class 2 - Trading vessels carrying up to 12 passengers
Class 3 - Fishing vessles
Class 1F - Hire and drive vessels
***select***
Not applicable
A - Unlimited area of operation
B - Offshore operations to 200 miles off the coast
C - Restricted offshore operations within a range of 30 miles from sheltered waters or safe haven
D - Operations within declared partially smooth waters
E - Operations within declared smooth waters
Please provide a copy of commercial registration certificates.
Registered Passenger Capacity*
Average Passenger Per Trip
Annual Passenger Numbers
Food Served
Alcohol Served
Will the vessel be used for private purposes?
Additional Comments
Owner's & Master's experience
Date this vessel was purchased
Master of this vessel since
Please provide details of previously owned vessels. Leave blank if none.
Master Name
Make & Model
Hull Length
Type (Power or Sail)
Length of Ownership
Area of Navigation
Please provide details of relevant licences and qualifications.
Master Name
Marine Licences / Qualifications
Date Obtained
Will others be permitted to operate vessel?
Number / details of crew
Claims & Convictions
Have you, the Proposer(s), or Drivers(s) in the past 5 years:
Had any insurances cancelled, refused or had special conditions imposed?
***select***
Yes
No
I don't know
If yes, please provide details
Made any boat insurance claims?
***select***
Yes
No
I don't know
Date of Loss
Description of Loss
Settlement Amount
Been charged or convicted with any offence?
***select***
Yes
No
I don't know
If yes, please provide details
Is there any other information you wish to tell us or think we should know?
***select***
Yes
No
I don't know
If yes, please provide details
General
Has your boat been surveyed?
***select***
Yes
No
If yes, please provide a copy
Is the vessel, or will it be under construction or undergoing a major refit?
***select***
Yes
No
If yes, please provide details
Options
THIRD PARTY LEGAL LIABILITY: The quote we will provide is for comprehensive insurance including Third Party Liability of $10,000,000
Do you require a different level of liability cover?
No
Yes
Number
PASSENGER LIABILITY: Do you require cover for passenger liability?
***select***
Yes
No
Reg Pax:
POLLUTION LIABILITY: Do you require cover for passenger liability?
***select***
Yes
No
Sum Insured
Purchase price
Purchase Date
If the total amount paid for everything is different from the agreed value nominated, please explain why.
Split up of Sum Insured
Hull & Fittings
Motor 1
Motor 2
Trailer
Equipment & Accessories (as listed above)
Masts, Spars, Rigging, Sails
$0.00
TOTAL SUM INSURED
*
including hull, motor, trailer, equipment & accessories
Additional Comments / Information:
Would you like Trident Marine Insurance to obtain a quote from a selection of P&I Clubs for liability limits in the vicinity of USD 500,000,000?
***select***
Yes please
No thanks
Please give me more info
Email
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