Jet-Ski Insurance Application

Jet-Ski or Personal Water Craft

Insurance Application
Lead Record ID
Lead Record Created by
Insurance Products

Jetski
Application form filled in by*
Office staff member:*
How did you hear about us?
Information about completing this form on-line

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By completing and submitting this application form you are consenting to have quotations for this class of insurance obtained from various insurance companies that provide this product and who have distribution agreements with United Insurance Group Pty Ltd and Insurance Web Pty Ltd. Quotations are provided to you obligation free. A completed form does NOT BIND the applicant to complete the insurance but does form part of any insurance contract that should develop from the information provided in this document. Persons completing this application must have the right authority to do so or must have the application reviewed and signed off by those persons with the authority to enter into contractual agreements for and on behalf of the entity named in this application. This quotation facility enables you to lodge a quote request direct to the Insurance Web Customer Service Team with the right information for quick and accurate assessment and thereby provides a superior service in dealing with insurance companies and you as our valued customer. Simply complete the on-line form and the information will be sent to the appropriate Customer Service team. Following receipt of your request, an email response will be forwarded to you within 2-4 business days.
We are committed to protecting your privacy and confidentiality in accordance with the Privacy Act 1988 (Cth)

Important - please read before completing this form
PrivacyWe are committed to protecting your privacy and confidentiality in accordance with the Privacy Act 1988 (Cth) and it is one our prime concerns that any personal or sensitive information you provide to us is not used for any other purpose than that intended and expected by you. This Privacy Policy overview below, describes our current policies and practices in relation to the handling and use of personal information. You may also see our Privacy policy in our Financial Services Guide (FSG).
What information do we collect and how do we use it?We will collect personal information for primary purposes, which are relevant to providing and administrating our products and services. We collect the information needed to enable us to provide advice on and arrange financial services. We will usually provide some or all of this information to our product suppliers. Some of these suppliers may be located outside Australia. To enable us to assess any claims made under an insurance policy we and our representatives (including loss adjusters, investigators, medical advisors and lawyers) collect information about the claim, some of which may be personal information. We may collect the information from you or from third parties. We provide this information to the insurer and those appointed to assist you in making a claim. We may use personal information internally to help us improve our services and help resolve any problems.
What if you don"t provide some information to us?We can only apply for and arrange financial service products if we have all relevant information. The insurance laws also require you to provide us with all the information we need in order to be able to decide whether to insure and on what terms.
How do we hold and protect your information?We hold the information we collect from you in our computer system and in our hard copy files. We ensure that your information is safe by following the usual security procedures expected by our clients.
Will we disclose the information we collect to anyone?We may disclose information to: • Insurers, underwriters, underwriting agencies, wholesale brokers and reinsurers (for the purpose of seeking recovery from them or to assist them to assess insurance risks);• Premium Funding companies for the purposes of gaining quotations on and arranging funding of your insurance premiums.• An investigator, assessor, State or Federal Health Authorities, lawyers, accountants, medical practitioners, hospitals or other professional advisors (for the purposes of investigating or assessing your claim);• A lawyer or recovery agent (for the purpose of defending an action by a third party against you or for the purpose of recovery costs including your excess);• Contractors who supply services to us, e.g. to handle mailings on our behalf.• An immediate family member; • Other companies in the event of a corporate sale, merger, reorganisation, dissolution or similar event However, we will do our best to ensure that they protect the information in the same way that we do. We may provide this information to others if we are required to do so by law or under some unusual other circumstances which the Privacy Act permits. We do not sell, trade, or rent personal information to others.

Duty of DisclosureBefore you enter into this contract of insurance with an insurer, the Insurance Contracts Act 1984 requires you to tell us and the insurer everything of which you are aware, which you know, or which a reasonable person in the circumstances could be expected to know is relevant to our decision, whether and on what terms your application for insurance is acceptable and to calculate the premium required for your policy. The Act imposes a different duty the first time you enter into the policy with us, from the duty that applies when you renew, vary, extend, reinstate or replace your policy. We set these duties out below. Your duty of disclosure applies when you enter into this policy with us for the first time. You will be asked various questions when you first apply for this policy. When you answer these questions, you must: • give us honest and complete answers;• tell us everything you know;• tell us everything that a reasonable person in the circumstances could be expected to tell us.
Who needs to tell usIt is important that you understand, that you are disclosing to us and answering our questions for both you and anyone else who you want to be covered by the policy.
Non-disclosure or MisrepresentationIf you do not tell us If you do not answer our questions honestly or do not properly disclose to us, the insurer may reduce or refuse to pay a claim or may cancel the policy. If you act fraudulently in answering our questions or not disclosing to us, the insurer in turn, may refuse to pay a claim or treat the policy as never having existed. This would mean that you were never insured.
Your duty of Disclosure applies when you renew, vary, extend, reinstate or replace your policyWhen you renew, vary, extend or reinstate your policy, your duty is to tell us before the renewal, variation, extension or reinstatement, every matter known to you, which: • you know; or• a reasonable person in the circumstances could be expected to know;• is relevant to an insurance providers decision whether to insure you and, if so, on what terms.
What you do not need to tell us when you renew, vary, extend or reinstate your policyYou do not need to tell us about any matter: • that diminishes the insurance providers risk;• that is of common knowledge;• that we know or should know as an insurer; or* that we tell you we do not need to know.
Non-disclosure and MisrepresentationIf you make a misrepresentation to us, or if you do not comply with your duty of disclosure and we issue your policy with terms and conditions that are different to the terms and conditions that would have been issued had there not been any misrepresentation, or your duty of disclosure had been complied with, then: • the insurer may reduce the cover provided, so that we are placed in the same position as they would have been in, had there not been any misrepresentation and your duty of disclosure had been complied with; and• the insurer may also cancel your policy; or• the insurer may treat your policy as if it never existed if the misrepresentation or your non-compliance with your duty of disclosure was fraudulent.
Policy DetailsFor full details of cover, please refer to the Product Disclosure Statement and/or Policy wording which sets out the terms and conditions of cover offered. This is available on request and will be sent out with your quotation once prepared.

Enter the proposed start date for insurance cover or the expiry date of the existing policy*

DayMonthYear
Your Contact Information
First Name*
Last Name*
Enter your E-mail address
Contact phone number*
Does the Insured Name(s) differ to your own name?*

YesNo
Enter Full name of the insured
Please enter your mailing address details
Mail Address Line One*
Mail Address Line Two
Enter Suburb or mail centre location*
Select Mail State*
Enter Mail Postcode*
Is the garaging or parking location overnight different from your mailing address?*

YesNo
Jet-Ski Garaging Location
Enter the details of where the Jet-Ski will be mostly based overnight
Address Line 1
Address Line 2
Enter Suburb or City*
Select State*
Enter Postcode*

Details of Your Vessel
Full name(s) of owners/insured parties
Owners Date of Birth

MonthDayYear
Date
I confirm the following: The vessel to be insured a) is used only for Private Use b) is not under construction c) has been professionally built d) will be located inside Australian waters*

TrueFalse
Please provide details of the above if "False" has been selected
Name on PWC:
The boat name if it is named
Is the Jet-Ski housed in or on a larger vessel?*

YesNo
How is the Jet-Ski stored/housed?*
What is the maximum speed the jet ski is capable of?*
Does the Jet-Ski have any non-standard modifications?*

YesNoI don't know...
Details of modifications and/or accessories*
Do you intend to take the Jet-Ski more than 5nm from mainland?*

YesNo
Please provide more details
Power/Construction

The Jet-Ski details
Year Built*
Make/Brand:*
Model:
Registration Number:
Hull Identification Number (HIN)
Length of the Jet-Ski or PWC
How many seats on the Jet-Ski?*
Motor Details
Make of Motor:*
Horse Power of Motor:*
Serial Number of Motor
Trailer Details
Do you wish to include the trailer in this policy?*

YesNo
Length of the Trailer:
Registration of Trailer:*
Jet Ski Value
Current Market Value (Including Equipment & Accessories)*
Current Market Value (Including Trailer and Equipment & Accessories)*
Original Purchase Price of the vessel
Approx Date of Purchase

DayMonthYear
Does the purchase price include all accessories on this quote request?

YesNo
Details of Accessories not already included in the sum insured values or added since the time of purchase:

Security Details
Please provide details of the methods used to secure the Jet-Ski:
Would you like to obtain assistance, quotes and/or advice on Marine Security from an alliance partner of Insurance Web Pty Ltd specialising in Marine Security Equipment?

YesNo
I would be interested in knowing more about:

Physical security of the boat at home and/or at the marinaAlarm systems availableSatellite Tracking systems availableCamera surveillance systemsAudio / Visual theft deterrentsOther
I give permission for a representative of Atlantis Security to contact me regarding security quotes and/or advice. www.atlantissecurity.com.au

Permission

Interested Parties
Do you wish to note any interested parties?*

YesNo
Name
Nature of Interest
Address 1
Address 2
Suburb
State
Postcode

Declaration
I/we in effecting insurance in accordance with the information provided in this application declare and warrant: A) The statements in this application form are true and correct;B) I/we have disclosed all matters which to my/our knowledge the insurer should be aware of;C) That I/we agree to accept that Insurance Web Pty Ltd will use this information in order to source insurance quotations from various insurance providers;D) That I/we agree to accept that on receipt of our quotation for insurance cover Insurance Web Pty Ltd shall also provide the relevant Product Disclosure Statement and/or Policy Wording for the insurance cover quoted;E) That I/we have access to and have read the relevant Financial Services Guide supplied on the website: www.insuranceweb.com.au and also supplied at time of quoting by email/post.
Proposer's Signature:
Proposer's Title:
Date:

DayMonthYear
* Below is to be hand completed on the hard copy printed form
Signature Signed X ...............................................................

Print name: ________________________________

Your Title: _____________________________

Dated: ......../......../..........
Should be Empty:

Jet-Ski or Personal Water Craft