Sailing Dinghy and Tender proposal

INSURED DETAILS

Have you been insured with Vero before?

Yes

If yes, previous Policy Number

Insured person(s)

Address

Address 2

City/Town

ZIP/Postal Code

Country

Telephone

Yacht Club

Desired start date of insurance cover

BOAT DETAILS

Make and Model

Name of Boat

Year Built

Length (m)

Construction Material

Sail Number

Trailer Make

Trailer Rego

Engine Manufacturer

Serial Number

Engine Year

Horsepower

Fuel Type

Petrol

Diesel

Date of Boat Purchase

Price Paid (NZD)

STORAGE DETAILS

Main Storage Address

What type of recognised security device(s) do you use?

Is the boat visible from the road?

Yes

Alternate Storage Address

Is your boat ever left moored on a swing, pile or in a marina berth?

Yes

If yes, what type / location & length of time?

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.

Boat sum insured ($)

Meaning the Hull and any fixtures, fittings and equipment which are normally sold with a boat, including its sails, masts, spars, rigging, machinery (inc compressors) and motors, anchors, chain, shackles, ropes and warp, fish finders, depth sounders, other navigational aids and marine radios.

Boat Trailer sum insured ($)

Boats Gear sum insured ($)

Meaning equipment that has a specific marine use which is kept permanently aboard but is not fixedincludingbinoculars, first aid kit, life jackets, wet weather gear including footwear, flares, tools, portable fire extinguishers, dive gear.

TOTAL SUM INSURED ($)

QUESTIONAIRE

	Have you (or any party you wish to name in the policy schedule, and any person who uses your boat with your express permission): click box on left if Yes, leave blank if No
Suffered loss or damage exceeding NZD $1,000 to any boat (whether insured or not)?	Suffered loss or damage exceeding NZD $1,000 to any boat (whether insured or not)?
Made a boat insurance claim?	Made a boat insurance claim?
Been subject to a lawsuit or a legal liability claim in respect of any boat?	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?	Been declared bankrupt, insolvent, or ever entered into an arrangement with creditors?
Had a boat repossessed?	Had a boat repossessed?
Had any insurance declined, cancelled, avoided, renewal refused, terms or conditions imposed or claim declined?	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?	Been accused of any criminal activity or had any criminal convictions, or acquittals or have any criminal prosecutions pending?

Is there any further information likely to affect this insurance?

Yes

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 informationtoAonNewZealand (“Aon“) whethertheinformationisaskedfor or not. Material information is information that might influence our 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 occurs prior to the commencement of cover, if the contract is varied and prior to each renewal. Failure to discloseall material information may result in Aon voiding your insurance policy.This means your policy would be deemed never to have existed and any claims would not be payable.

Privacy Act 2020

This proposal collects personal information in order to evaluate your insurance requirements for the purpose of deciding whether to issue insurancecover and if so, on whatterms. Theinformationcollectedwill be held by Aon at Auckland. Failure to provideanypersonal information requested may result in your application for insurance being declined. Personal information may need to be disclosed to entities located outside of New Zealand such as insurers and reinsurers who may not be subject to data protection laws that are comparable to those in New Zealand. Individualshave a right to requestaccessto and correction of their personal information subject to the Privacy Act 2020.

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 Aon.

2. This Proposal shall be the basis of the contract between me/usand Aon, and I am/we are willing to accept cover subject to Aon’s policy terms, conditions, exclusions and any special terms they may require.

I/We authorise:

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

I/We agree:

To Aon disclosing personal information to third parties such as insurers who may be located outside of New Zealand and who may not be subject to data protection laws that are comparable to those in New Zealand.

I/We confirm:

That I/We have obtained the consent of any other person whose personal information I/we provide to Aon as part of this application or under any resulting policy or claim, to disclose their personal information to third parties such as insurers who may be located outside of New Zealand, having advised them that those third parties may not be subject to comparable data protection laws to those in New Zealand.

I/We undertake:

To inform Aon immediately of any material events or changes in circumstances which occur after the commencement of this policy or after any renewal.

ACCEPTANCE OF DECLARATION

I have read and understand the declaration above

Name of the Proposer (s)

Date

Who was your Insurance Company for the last 12 months?