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I am interested in:

Title
First Name*	Last Name*
Address
Suburb	State Post Code
Country
Telephone	Mobile
Email*

Type of Cover	Comprehensive Third Party Water Skiing Liability

Insured(s) Details:	Have you had any insurance refused or cancelled?... Yes No
	Have you had any theft claims in the last five Years? Yes No
	Have you had any boat claims in the last five Years? Yes No
	Been convicted of any offence in the last five Years? Yes No

Boating Experience:	Years: Insured Age:
	Boating Course ..... Yes No

Vessel Details:	Make: Model:
	Year:. Lenght (ft/mtr):
	Max Speed (Knots or km/h):
	Hull Construction Material:...
Motors:	Make: Power:
	Year:.
	Inboard Outboard Stern Drive Jet Other
	Petrol.. Diesel.... Gas.......... Other

Sailing Boats:	Running Backstays................... . Yes No
Masts, Spars, Rigg:	3 or more Sweptback Spreaders... Yes No
	Rod Rigged................................ Yes No
	2 or more Inline Spreaders.. ........... Yes No
	Carbon Mast .............................. Yes No
	Age of Rig:.. ........

Legal Liability:	Select liability required: $5,000,000 $10,000,000
Boat Value:	Total Sum Insured:

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