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Sailing Dinghy and Tender Proposal

      

Aon contact details: Sam Gunn +64 9 362 9071. Email Sam 

Insurer: Vero Marine Insurance, an operating division of Vero Insurance New Zealand Limited (“Vero”)

INSURED DETAILS

BOAT DETAILS

$

STORAGE DETAILS

AMOUNT TO BE INSURED

This policy is an Agreed Value Wording, therefore the sum insured specified below will be the maximum sum's insured Vero will pay in a total loss scenario.

$
meaning hull, fixtures, fittings and equipment normally sold with a boat
$
$
meaning equipment that has a specific marine use which is kept permanently aboard but is not fixed
$

QUESTIONAIRE

YesNo
Suffered loss or damage exceeding NZD $1,000 to any boat (whether insured or not)? *
Made a boat insurance claim? *
Been subject to a lawsuit or a legal liability claim in respect of any boat? *
Been declared bankrupt, insolvent, or ever entered into an arrangement with creditors? *
Had a boat repossessed? *
Had any insurance declined, cancelled, avoided, renewal refused, terms or conditions imposed or claim declined? *
Been accused of any criminal activity or had any criminal convictions, or acquittals or have any criminal prosecutions pending? *
If you have answered "Yes" to any of the above questions, please provide full details below. Details should also include the name of the insurance company(s) and policy number(s) where applicable.

Duty of Disclosure

Subject to the rights set out in the Criminal Records (Clean Slate) Act 2004 (“Clean Slate Act”), you are under a duty to disclose all material information to Vero whether the information is asked for or not. Material information is information that might influence Vero's decision to insure you and if so on what terms and/or premium. All information given must be complete and correct. If you have any doubt as to whether a fact is material then it should be disclosed. The duty to disclose all material information applies prior to the commencement of cover, if the contract is varied and prior to each renewal. Failure to disclose all material information may result in Vero voiding your insurance policy. This means your policy may be deemed never to have existed and any claims may not be payable.

Privacy Act 1993

This proposal collects personal information in order to evaluate your insurance requirements for the purpose of deciding whether to issue insurance cover and if so on what terms. The information collected will be held by Aon and/or Vero at Auckland. Failure to provide any personal information requested may result in your application for insurance being declined. You have a right to request access to and correction of your personal information subject to the Privacy Act 1993.

Declaration

I/We declare that:

  1. Subject to any rights I/We have under the Clean Slate Act, the information given is in every respect correct and complete and all material information has been disclosed to Vero.
  2. I/We undertake to exercise all ordinary and reasonable precautions for the safety of the vessel and I/We warrant that the boat is well found and in every respect seaworthy.
  3. This Proposal shall be the basis of the contract between me/us and Vero, and I am/we are willing to accept cover subject to Vero’s policy terms, conditions, exclusions and any special terms they may require.
  4. I/We are fully authorised to complete and sign this proposal on behalf of the person(s) named in the proposal.

I/We authorise:

  1. Vero 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.
  2. Vero to use my/our personal information to advise me/us of Vero’s products and/or services.

I/We undertake:

To inform Vero 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.