Page 1 of 6
YACHTING AUSTRALIA INC.
OVERSEAS TRANSIT AND RACING INSURANCE PROPOSAL FORM
1. INSURED(S):
Name of Insured(s): _____________________________________________________________________
Postal Address: ________________________________________________________________________ Email Address: ______________________________________ Phone No.__________________________ Driver Licence: ______________________________________ Expiry Date: _______/_______/_________
2. INSURED YACHT:
Type of Yacht to be insured:________________________________________________________________
Detail method pf packing: __________________________________________________________________ (Taking yacht overseas)
Name of ship or Carrier for Cargo:___________________________________________________________ Name of Shipping Line (if Applicable): ________________________________________________________
Transit: Country From: ________________________Country To: ______________________ And return voyage: _____________________________________________________
Period of cover: From: _______/______/______ To: _______/______/______
INSURER: NAUTILUS MARINE INSURANCE AGENCY PTY LTD (ABN 34 100 633 038) 28-32 George Street, Sandringham VIC 3191
Telephone No: 1300 780 533
www.nautilusinsurance.com.au
Page 2 of 6
3. THE INSURED YACHT (VESSEL): HULL
Boat Name Reg/Sail No. Year Built Construction Material
__________________ _____________ _________ _____________________
Length Make Model Professional or Amateur Built Max Speed ________Mtrs ______________ Knot
4. MAIN ENGINES
Engine Make HP Model Year Serial No: Fuel ______________ _____ ___________ ______ _________________________ _______
5. EQUIPMENT & ACCESSORIES:
(Eg. Tender/s, Radio, Nav. Aids, Sat Nav., Safety Equipment, Covers ect.)
List items & values over $1,000 (add list if more space required) included in Equipment and Accessories Sum Insured
a. ________________ $________________ d. ________________ $ ________________
b. ________________ $________________ e. ________________ $ ________________
c. ________________ $________________ f. ________________ $ ________________
Total Equipment & Accessories Sum Insured $ _______________________ 6. SAILS, MAST,SPARS AND RIGGING:
Mast Construction ________________________
Type of Rig: Masthead Fractional
Rod Rigged: Yes No
Number of Spreaders: _______________ Type of Spreaders: Swept Back Inline: 7. TRAILER:
Registration No. Make Age
_____________________ ______________________ (Years)
Page 3 of 6 8. HISTORY:
Have you or any other owner of the boat:
SPECIAL NOTE FOR CHARTERING:
If coverage is required when chartering a yacht, when LIABILITY COVERAGE ONLY is required:
Page 4 of 6
YACHTING AUSTRALIA INC.
OVERSEAS TRANSIT AND RACING INSURANCE PROPOSAL FORM LAW
The Insurance, if accepted, will be subject to Australian Law.
Depending on the use of the yacht, the insurance, if accepted, may be subject to the provisions of the Marine Insurance Act 1909 or the provisions of the Insurance Act 1984.
If this proposal form is completed in whole or in part by any person other than the Insured, then such person shall be deemed to be the agent of the Insured and not the agent of Nautilus Marine Insurance Agency Pty Ltd.
The Insured who completed the proposal form has his/her attention drawn to the terms of Section 23 to 27 of the Marine Insurance Act 1909 and in particular is informed that the contract of marine insurance that may be made and which may have as its basis the material contained herein, is a contact based upon the utmost good faith and in the absence of such good faith, may be avoided. Further, the Insured is informed that there is an obligation to disclose to the Insurers every material circumstance which is known to the proposed insurer. Every circumstance is material if it would influence the judgement of a prudent Insurer in fixing the premium or determining whether they will take the risk. If there is a failure to make such disclosure, the Insurers may avoid any contract of insurance that may be made. The Insured who completes this proposal form is advised that the Insurers will not be liable for any loss or damage attributable to unseaworthiness where the vessel is operated whilst in an unseaworthy condition with the privy of the owner. The Insured warrants that the vessel, which is subject to the proposed contract of marine insurance, will at all times be manned and operated as per all appropriate Government Regulations.
DUTY OF DISCLOSURE
Before you enter into a contract of general insurance with Insurers, you have a duty, under the Insurance Contracts Act 1984 to disclose to Insurers every matter that you know, or could reasonably be expected to know, is relevant to the insurers decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the insurers before you renew, extend, vary or reinstate a contract of general insurance. Your duty does not require disclosure of matter:
The diminishes the risk to be undertaken by the Insurers;
That is common knowledge;
That the Insurers know, or in the ordinary course of their business, ought to know;
As to which compliance with your duty is waived by the insurers. NON-DISCLOSURE
If you fail to comply with your duty of disclosure, the insurers may be entitled to reduce their liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the Insurers may also have the option of avoiding the contract from the beginning.
DECLARATION BY INSUREDS
I/We hereby declare that to the best of my/our knowledge and belief:
1. The information provided herein is true and correct in every respect and I/we have not withheld any material information which would influence the decision of the Insurers in regard to this proposal.
2. The sums proposed for insurance represent the full value.
3. I/We have received the proposal/information sheet and agree to accept the insurance subject to the terms, conditions, exclusions and limitation of the policy.
4. I/We agree that this proposal will be the basis of the contract of insurance should the proposal be accepted.
Page 5 of 6
YACHTING AUSTRALIA INC.
PREMIUM SCHEDULE
OVERSEAS TRANSIT AND COMPETITION COVER
HULL AND LIABILITY COVER
SUM INSURED
UP TO TWO MONTHS
ADDITIONAL MONTH
Up to $5,000
Or Liability Cover Only
$230.00
$37.50
$ 5,001 to $10,000
$315.00
$57.50
$10,001 to $20,000
$400.00
$72.50
$20,001 to $ 30,000
$465.00
$90.00
$ 30,001 to $40,000
$530.00
$110.00
$40,001 to $50,000
$605.00
$130.00
$50,001 to $60,000
$680.00
$140.00
$60,001 to $70,000
$765.00
$160.00
USA & Canada Add $55.00 plus $22.50 per
month
THESE PREMIUMS ARE NON-REFUNDABLE DUE TO ANY CAUSE.
THESE PREMIUMS INCLUDE BROKER’S FEE CHARGES
Cover includes: Transit by sea and land conveyance, commencing from the time of hand over to cartage contractor and/or ships agent, whichever shall be first occurring and ceasing at the time of delivery and extends to include return transit to Australia
Hull: Includes Racing Risk Extension, excluding ocean/bluewater racing and terrorism. Covers for both competition and training use.
Liability: Limit of $10,000,000 is included
Excess: 2% of Sum Insured with minimum of $500 each and every claim.
Please charge this purchase to my MasterCard / Visa (Circle One)
Card Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ (surcharge 1.50%)
Valid from ________ \ ________ until end ________ \ ________
Security No _________ At the back of the card
Name of Cardholder ____________________________Signature of Cardholder _____________________
WHEN FORDS ARE COMPLETED, PLEASE EMAIL
Page 6 of 6
