RIB - Boat Insurance Needs Analysis

Boat Insurance Needs Analysis
Broker Email Address - a copy of the form will be sent to this address
example@example.com
Client Reference
Date of Enquiry

DayMonthYear
Date
Policy Due Date

DayMonthYear
Date
Current Insurer
Who referred client?
Sales Team
Insured Details
Insured Name
Date of Birth

DayMonthYear
Date
Type of Finance
Geographic Limits
Client Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: 0000000000.
Boating Experience (Years)
Section 1: Boat Details

Hull ** please note: Hull includes sails, masts, spars & rigging

Motor

Motor

Trailer

Has the Insured or any other owner of the boat:

Rows	Yes or No
Ever had a claim refused or cancelled or declined or special conditions imposed on a boat policy in the last 5 years?
Suffered claims of any nature in the last 5 years?
Been convicted of, or had any fines or penalties imposed for any crime involving drugs, dishonesty, arson, theft, fraud or violence against any person or property in the last 5 years?
Been declared bankrupt and not discharged within the last 12 months?
Is the boat maintained in working order?
Has the boat been modified?
Are there any exceptional circumstances relating to the risk to be insured that you have not already told us about and that you know or should know may affect the Insurer’s decision to accept the insurance?

Boat Insurance Needs Analysis