Ararat: 03 5352 2661 info@grampiansinsurance.com.au

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boat, jet ski, more

Pleasure Craft

Do you love the great outdoors? Have you worked tirelessly so you can indulge in some special boating activities?

To get your free, no obligation quote fill out our online Pleasure Craft Analysis form below. Alternatively, please call our Ararat office on 03 5352 2661 or our Stawell office on 03 5358 4030.

Pleasure Craft Needs Analysis Form

Please complete this form so we can provide you with the most accurate quote possible.

Thank you for connecting with us. We will respond to you shortly.

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*Name(s)

*Inception Date

*Date of birth

*Email

*Postal Address

*Contact number

*Noted Finance

*Type of cover required

Comprehensive

Third party only

Private / business

*Purchase Date

*Purchase Price

*Years of boating experience

*Hull year, make and model

*Hull sum insured for

*Boat name

*Registration

*Construction type

Aluminium

Fiberglass

Wood

Carbon

Other

*Motor year, make & Model

Motor sum insured

*Type of Motor

Inboard

Outboard

Maximum speed of boat (knots or kph)

*Mount

Rear mount

Mid mount

Sterndrive

Jet

*Fuel type

Petrol

Diesel

Gas

Trailer year, make & model

Trailer sum insured

Trailer Registration

*Water skiers liability

Yes

No

*Fire Extinguisher

None

Manual

Automatic

*Total sum insured

*Stored location

*How is the boat stored

Lay up months (if any)

None

Jan

Feb

Mar

April

May

Jun

July

Aug

Sep

Oct

Nov

Dec

In the last five years has the insured;

*Had insurance cancelled, declined or special terms imposed?

Yes

No

*

*Been charged or convicted of a criminal offence?

Yes

No

*

*Been declared bankrupt or been placed in receivership?

Yes

No

*

*Made any claims?

Yes

No

*

Notes

Areas we Serve

Ararat

Horsham

Ballarat

Hamilton

Gippsland

Stawell

Melbourne

Warrnambool

Bendigo

Wodonga

Get In Touch

Name

Email Address

Phone Number

Message

Grampians
Insurance Brokers

Address:

99 Barkly St
PO Box 118
Ararat VIC 3377

Phone:

Fax:

03 5352 3208

Email:

info@grampiansinsurance.com.au

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