Application Form

Jet Ski Insurance

No cover applies for burglary/theft if the ski or skis are not kept in a locked garage when not in use.

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It is agreed when you take the Jet Ski away on holiday and the like, it is simply not practical to have it kept in a locked building and it is therefore accepted and classified as being “in use”. Notwithstanding that, in such cases a good level of security is still required (eg. ski locked to the trailer and trailer fitted with a wheel clamp).

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The sum to be insured represents the market value of the property described, and I/we agree to update the sum insured at each renewal to continue market value insurance.

Name of Dealer / Agent (if applicable)

Date cover to start from *

The Insured

First Name *

Last Name *

Email Address *

Phone *

Address *

City *

Postcode *

Country *

Date of Birth *

Do you prefer correspondence to be via email or mail? *EmailMail

Finance company (or other interested party)

How did you hear about us? *

Which advertisement?

Broker Name

Boat Dealer Name

Details

Jet Skis Insured

Being the hull, fixtures, cover, fittings and motor of each vessel.

Jet Ski #1

Make and Model of Jet Ski *

Motor cc or Horsepower *

Serial Number *

How many seats does the Jet Ski have? *

Jet Ski #1 Sum Insured $ (GST Inclusive) *

NZD

Add another Jet Ski?Yes

Jet Ski #2

Year Built *

Make and Model of Jet Ski *

Motor cc or Horsepower *

Serial Number *

How many seats does the Jet Ski have? *

Jet Ski #2 Sum Insured $ (GST Inclusive) *

NZD

Add another Jet Ski?Yes

Jet Ski #3

Year Built *

Make and Model of Jet Ski *

Motor cc or Horsepower *

Serial Number *

How many seats does the Jet Ski have? *

Jet Ski #3 Sum Insured $ (GST Inclusive) *

NZD

More than 3 Jet Skis to insure? Please contact us directly on:
0508 628 8425

Trailer Insured

Do you have and want to insure a trailer for this Jet Ski? *YesNo

Registration Number *

Year Built *

Make and Description *

Trailer Sum Insured $ (GST Inclusive) *

NZD

Other Property Insured

Do you have and want to insure other property for this Jet Ski? *YesNo

Such as life jackets, buoyancy aids, safety helmets but excluding fishing gear, towables and property covered under a home contents policy.

Description

Other Property Sum Insured $ (GST Inclusive) *

NZD

Total Sum Insured GST inclusive (If applicable: Jet Skis, Trailer & Other Property)

$including GST

Legal Liabilities to Third Parties

Limit of indemnity:
$10,000,000 including GST

Claim Excess

$500
(except for claims arising out of burglary or damage caused in the course of burglary or any attempt thereat, theft or illegal conversion where the Excess shall be $1,000)

General Questions

Is this Jet Ski used solely for private pleasure? *YesNo

Does the main user have different details to The Insured (above)? *YesNo

Main User First Name *

Main User Last Name *

Main User Birthdate *

Is/Are Jet Ski(s) kept in a locked garage when not in use? *YesNoNote: See definition for travel vs. garage at the beginning of this form.

Garage locked? *YesNo

Garage alarmed? *YesNo

Is the garage address the same as above for "The Insured"? *YesNo

Please provide the garage address *

City *

ZIP / Postal Code *

Country *

You are aware that if the Jet Ski is at this address and NOT in a locked garage or building, there is no cover for Theft *Yes

Have you installed security device(s) on Jet Ski or Trailer? *YesNo

Security Devices Installed *Please list what security devices have been installed.

If the Ski is ‘in use’ (as defined) a minimum of a trailer lock and the Ski locked to the trailer is required.

Has engine been modified? *YesNo

Details of engine modification *

Will you be racing your Jet Ski? *YesNo

NOTE: racing, time trials and speed tests are NOT INSURED.

Will anyone under 21 be operating the Jet Ski? *YesNo

Operator 1 First Name

Operator 1 Last Name

Under 21 Operator 1 Date of Birth

Operator 2 First Name

Operator 2 Last Name

Under 21 Operator 2 Date of Birth

Have you had any Jet Ski or Boating claims? *YesNo

Details of Claims *

Have you had any criminal convictions? *YesNo

Details of Convictions *

Have you ever been insolvent, wound up, liquidated, or prosecuted for fraud/dishonesty? *YesNo

Details of Insolvency/Fraud *

Your Duty of Disclosure

When applying for insurance, you have a legal duty of disclosure to the insurer — to truthfully disclose all information that is relevant and/or material to the insurer, so as to enable it to decide whether to provide this insurance, and (if so) on what terms. You have this duty every time your policy renews and whenever you make changes to this policy.

If you breach this duty, then the insurer may elect to void your policy from inception or the last renewal date. This means that the policy will be treated as if it never existed

The duty to disclose relevant or material information is not limited to the questions listed in the proposal (if a proposal form is completed). Please ask us if you are not sure whether you need to disclose information.

Pursuant to the Privacy Act 1993

The following is brought to your attention:

This proposal collects personal information about you;
The information is collected to evaluate the insurance you seek;
The intended recipients of the information are Nautical Insurance and Vero Insurance;
The information is being collected and held by Nautical Insurance and Vero Insurance;
The collection of this information is required pursuant to the common law duty to disclose all material facts relevant to the insurance sought, and is mandatory;
The failure to provide this information may result in your application for insurance being declined or your insurance being void from the beginning;
You have rights of access to and correction of this information, subject to the provisions of the Privacy Act 1993.

I/we thereby warrant that no insurance company has refused or cancelled insurance, that the jet ski (PWC) is well found and in every respect seaworthy, and that the above statements and particulars are true.

I/we agree that the proposal and declaration shall be the basis of the contract.

Insurance Charges and Fees

By entering this contract of insurance, you agree to the following:

we may include a fee in the insurance charge;
we shall be entitled to charge you an additional administration fee for any alteration or adjustment to the policy that requires the production of further materials in relation to your cover;
in the event of cancellation of the policy, we are entitled to retain our remuneration including fees, commissions and brokerage paid by the insurer.

Insurer Financial Strength Rating

Vero Insurance New Zealand Limited has been given an AA- financial strength rating by Standard and Poor’s. The rating outlook is Stable.

The rating scale is available from the Vero Insurance website.

Privacy Act and the Insurance Claims Register

The Insurance Claims Register (ICR) is a database of insurance claims to which participant insurers have access. The purpose of the ICR is to prevent insurance fraud. The ICR is operated by Insurance Claims Register (ICR Ltd), PO Box 474, Wellington 6140.

This policy is issued to you on the condition that you authorise the insurer to place any claims made against this policy on the database of ICR Ltd, where they will be retained and be available for other insurance companies to inspect. You authorise the insurer to obtain from ICR Ltd personal information about you that is (in their view) relevant to this policy or any claims against it.

You have certain rights of access to and correction of this information subject to provisions of the Privacy Act 1993.

Declaration

Please read & agree.

By completing and submitting this proposal form, I/we declared that to the best of my/our knowledge and belief these particulars are true, complete and correct. Subject to any right I/we have under the Clean Slate Act, I/we have not withheld any information or any other material fact likely to affect the provision of cover by Nautical / Vero Marine Limited.

I/We declare that:

Subject to any right I/we have under the Clean Slate Act, the information given is in every respect correct and complete and all material information, including details of previous losses/claims, has been disclosed to Nautical/Vero Marine.
I/we undertake to exercise all ordinary and reasonable precautions for the safety of the items insured.
This application shall be the basis of the contract between Nautical/Vero Marine and myself/ourselves; and I am/we are willing to accept cover subject to Nautical/Vero Marine’s policy terms, conditions, exclusions and any special terms they may require.
The figures shown represent the current market value on the New Zealand market, or if less than 3 years old, the replacement value.
I/We are fully authorised to complete and sign this application on behalf of the person(s) named in the proposal.

I/We authorise:

Nautical/Vero Marine 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 me/us and any claim(s) made by me/us.

I/We undertake to inform Nautical/Vero Marine immediately of any material events or changes in circumstances which occur after the commencement of this policy and whenever the contract is varied or renewed. This insurance will not be in force until this proposal has been accepted by Nautical/Vero Marine.

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