Boat / Watercraft

What would you like us to do? (our Scope of Service)*

Add a boat to my existing policyReplace existing boat on my policyCreate a new boat policy

Policy Number

If known

What boat will this replace?

Are you:

Selling the old boat on the same date as purchasing the new boat (or trading in), so we can remove the insurance for your old boatStill waiting for your old boat to sell, so we won't cancel this until you can confirm it has sold

Name of person completing the form*

First NameLast Name

Are you the registered owner of the boat?*

YesNo

Who is the registered owner?

e.g. another person, company, trust

Is the policy to be issued in the name of the registered owner?

YesNo

Who should the policy be issued in the name of?

e.g. another person, company, trust

Postal Address

this needs to be house number, street, suburb, town, postcode

Address boat will be located if different from above

If moored, add mooring location here

E-mail

Phone Number

Area CodePhone Number

What date do you want cover effective from?*

DayMonthYear

What type of boat is this?*

Will there be any commercial use of the boat?*

YesNo

What kind of commercial use?*

Commercial fishingCharter boatOther

Please provide a further description of the business use of the boat

Will the boat be raced?*

YesNo

Is the boat:*

MooredTraileredOther

Type of mooring:*

MarinaPileSwingOther

Does the mooring meet the minimum port or local authority requirements for:*

	Yes/No
The size of the boat
Its conditions

Please provide details of any theft prevention and security devices on the boat:*

Where is the boat generally kept?*

What security does the boat/trailer have?*

What do you require cover for?*

What year was the boat built?*

As the boat is over 25 years old, can you please upload images of the exterior and interior of the boat (or email these to us at info@teamrussell.co.nz).

Browse Files

What material is the boat made out of?*

Boat (hull, fixtures, fittings) details -

	Details
Make
Model
Boat name and/or number
Length (specify in metres or feet)
Value ($)

Trailer details -

	Details
Year of manufacture
Make
Registration number
Value ($)

Main motor details -

	Details
Year of manufacture
Make
Horsepower
Value ($)

Auxiliary motor details -

	Details
Year of manufacture
Make
Horsepower
Value ($)

Dinghy details -

	Details
Year of manufacture
Make
Length (metres or feet)
Value ($)

Fishing and sporting equipment details -

	Details
Value ($)

Sails, masts, spars, rigging details -

	Details
Value ($)

Do the above figures include or exclude GST?*

incl GSTexcl GST

Under finance or lease?*

YesNo

Please provide detail if under finance or lease*

Name and address of financier

Is the boat sound and seaworthy?*

YesNo

Do you belong to a boat club?*

YesNo

What is the name of the boat club?

Please provide details of any relevant experience in handling boats, and any boating qualifications for yourself and anybody else operating the boat:*

Are any fire extinguishers kept on board?*

YesNo

How many?*

1. You authorise the insurer to give and obtain from other Insurance Companies, Insurance Brokers, the Insurance Claims Register Ltd or any other party any information relating to this or any other insurance held or previously held by you, and any claim(s) made by you, and any information you have provided now or previously for the purpose of payment.

2. You authorise the insurer to use your personal information to advise of their products and services.

Have you read, and understood the above authorisation statements?*

YesNo

1. You declare that subject to any rights you have under the Clean Slate Act, the information given is in every respect correct and complete and all material information has been disclosed to us.

2. You declare that the information contained in this document shall be the basis of the contract between you and the insurer, and you are willing to accept cover subject to their policy terms, conditions, exclusions and any special terms that they may require.

Have you read, and understood the above declaration statements?*

YesNo

Please click here to open our Scope of Service.

I acknowledge I have read, and understand the Scope of Service including the Adviser disclosure.*

Yes

Additional notes or queries that may affect your insurance?

Is there anything else you would like assistance with? (we will contact you)

Boat / Watercraft Insurance

Boat / Watercraft Details

General Details

Declaration & Privacy Statement

Authorisation