Boat Safety Information Form
Complete this form to provide essential boat safety, vessel, and insurance information.
Boat Name
*
Maritime Registration No
*
Owner’s Name
*
Address
*
P/C
*
State
*
Mobile Telephone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Telephone Private
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Emergency Contact Name & Number
*
Length
*
Make (Boat)
*
Hull Colour
*
Superstructure
*
Distinctive Features or Markings
*
No. of people safely carried at sea
*
Moored at
*
Fuel - Type
*
Fuel Capacity
*
Fuel Range
*
Motor/s Inboard Make
*
Inboard Motors Quantity
*
Please Select
0
1
2
3
4
Outboard Make
*
Outboard Motors Quantity
*
Please Select
0
1
2
3
4
Flares
*
Flares On Board
Life Raft
*
Life Raft On Board
Life Raft Type
*
Life Raft Colour
*
Life Raft Capacity
*
Life Buoy
*
Life Buoy On Board
Life Buoy Type
*
Life Buoy Colour
*
Life Buoy Number
*
Life Jackets
*
Life Jackets On Board
Life Jackets Type
*
Life Jackets Colour
*
Life Jackets Number
*
Radio
*
Radio On Board
Radio SSB HF
*
Radio SSB HF Frequencies
*
Radio 27MHz
*
Radio 27MHz Frequencies
*
Radio VHF
*
Radio VHF Frequencies
*
EPIRB
*
EPIRB On Board
Radar
*
Radar On Board
Radar Type
*
Radar Range
*
GPS
*
GPS On Board
GPS Type
*
Depth Sounder
*
Depth Sounder On Board
Depth Sounder Type
*
Depth Sounder Depth
*
Compasses
*
Compasses On Board
Compasses Type
*
Food on Board
*
Food On Board
Food on Board - No. of Days
*
Water (Litres/Gallons)
*
Sea Anchor
*
Sea Anchor On Board
First Aid Kit
*
First Aid Kit On Board
Insurer
*
Policy Number
*
Expiry Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature
*
Date (Signature)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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