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 Brokers National 

Brokers National Boat Insurance Cover Includes: Boat / Hull, Engine / Motor, Trailer, & Liability                                                  Did You Know You Can Extend The Policy To Include: Waters Skiers Liability, & Racing Liability                                     Simply Answer The Questions Below                                 Sometimes The Insurer May Ask For A Photo Or Marine Survey Of Your Boat                       

EMAIL Or FAX:

On-Line Boat Insurance Quote


Thank you for considering our on-line boat insurance quote service. Brokers National has accounts with most insurers and underwriting agencies. We aim to find you the best boat insurance deal possible.

Please fill in the following form - answering all questions, then either:

1. Click on "Send Email" to Brokers National at the bottom of this form. OR

2. Highlight this form to "Print It" and then "Fax It" to our office on 03 9791 6633.

Use the Mouse or the Tab key to move to the next field. We will respond with quotes as soon as they have been received from our insurers.

Boat Insurance

Boat & Engine Details:
(Only answer questions relevant to your boat - otherwise leave fields blank)

Boat - Make:
Boat - Type:
Boat - Year of Manufacture:

Boat - Length:

 metres
Boat - Construction:
Boat - Current Estimated Value Of Boat: $

Engines / Motors - Make & Model:

  
Engine - Year of Manufacture:                  

Engine - Size:

 HP            HP
Maximum Speed: knots        knots
Type of Engine / Motor 

Inboard                  Outboard                  
Sterndrive              Petrol
Jet                        Diesel
 Trailer - Make & Model:
Trailer - Year of Manufacture:
If applicable, what are the sails made of:
Do you want liability cover for racing? Yes No
Need water skiers liability risk extension ? Yes No
Accessories - List Items & Sum Insured:
(Only items worth over $500 to be covered)		 1 $
2 $
3 $
Is the boat laid up some months each year?  Yes No
If Yes, Please list the months laid up:
Do you have a loan on the boat? Yes No


Applicant Details:

Date of birth of applicant (DD/MM/YYYY):   Percentage of use: %
Occupation of applicant:  
How long have you held a boat licence?   years
Are you entitled to a No Claim Bonus with your current insurer? Yes     No
If yes, please specify what rating:
How many years has it been since your last claim? 

For each other person who will use, tow or carry your boat:

Date of birth of applicant 2 (DD/MM/YYYY):   Percentage of use: %
How long have you held a boat licence?   years
Date of birth of applicant 3 (DD/MM/YYYY):   Percentage of use: %
How long have you held a boat licence?   years

Have any of the applicants:
(Note: you must answer these questions)

Ever had any insurances refused or cancelled?     Yes No    
Details:
Suffered any claims in the last five years?   Yes No      
Details:
Been charged or convicted of any offence in the last  years?   Yes No      
Details:


Any other comments, requests or relevant information you need to add:


Contacting you about your quote: 
Please make sure you leave a contact phone number and the best time to call you.
Your Name:
Company Name:
Your Phone Number & Area Code:
Best Time(s) To Call:
Please send my quote by (select at least one): email     phone     fax     mail
Your Email:
Your Facsimile:
Your Postal Address:  

"Click On" Email Quote To Send Form To Us
 

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