Application Form

Trailered Boat Insurance

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Name of Boat Dealer / Agent (if applicable)

Date cover to start from *

The Insured

First Name *

Last Name *

Email Address *

Phone *

Address *

City *

Postcode *

Country

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

Vessel Insured

Vessel is the hull, fixtures and fittings.

Vessel Name

Year Built *

Make and Model *

Construction *

Please describe the construction: *

Hull Sum Insured $ (GST Inclusive) *

NZD

Motor Insured

Year Built *

Make and Model *

Horsepower *

Serial Number *

Motor Sum Insured $ (GST Inclusive) *

NZD

Add a 2nd motor?Yes

2nd Motor

Year Built *

Make and Model *

Horsepower *

Serial Number *

Motor Sum Insured $ (GST Inclusive) *

NZD

Auxiliary Motor Insured

Do you have and want to insure an auxiliary for this vessel? *YesNo

Year Built *

Make and Model *

Horsepower *

Serial Number

Auxiliary Sum Insured $ (GST Inclusive) *

NZD

Trailer Insured

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

Registration Number *

Year Built *

Make

Axles *

Please describe the trailer *

Trailer Sum Insured $ (GST Inclusive) *

NZD

Other Property Insured

Do you have and want to insure other property with this vessel? *YesNo

Not covered: personal effects, water skis, water toys, fishing and diving gear.

Description

Other Property Sum Insured $ (GST Inclusive) *

NZD

Total Sum Insured GST inclusive (If applicable: Vessel, Motor/s, Auxiliary, Trailer & Other)

$including GST

Legal Liabilities to Third Parties

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

Claim Excess (all claims)

Please select *$250$500$1000Other

Please enter your excess

NZD

Note: An additional excess of $250 will apply to any yacht whilst engaged in racing or trials, or in preparation thereof.

Storage

Address where the vessel will be kept when not in use.

Street Address *

City *

ZIP / Postal Code *

Country *

General Questions

Is this Vessel used solely for private pleasure? *YesNo

What security device(s) is/are on Vessel or Trailer? *Tow bar lockWheel clampOther

Details of security devices *

Will you be racing your Vessel? *YesNo

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 vessel 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.

Yes, I have read & agree to the declaration - Please tick the box.

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