Skip to content
1300 446 787
Financial Services Guide
Geotech and Structural Engineer Insurance
Child Care Centre Insurance
Bus and Coach Insurance
Strata Management Insurance
Fine Arts Insurance
Business Interruption Insurance
Corporate Travel Insurance
Cyber Protection Insurance
Mobile Plant & Machinery Insurance
Professional Indemnity Insurance
Management Liability Insurance
Boat & Pleasure Craft Insurance
Marine Transit Insurance
Commercial & Strata Insurance
Retail Shop Property Insurance
Death and Disability Insurance
Business Insurance Quote
Crop Insurance Form
Cyber Insurance Questionnaire
Fine Arts Insurance Questionnaire
Fire, Impact and Storm Insurance Claim
General Insurance Claim
Glass Insurance Claim
Motor Vehicle Insurance Claim
Machinery Breakdown / Fusion Insurance Claim
Public Liability Claim
Make a Claim
The issue of this form does not constitute an admission of liability on the part of the insurer.
Are you registered for GST purposes?
Have you claimed an input tax credit on the GST amount applicable to this policy?
Specify the percentage amount claimed
What is your Australian Business Number (ABN)?
For what purpose was the vessel being used at the time of the accident? (Tick where applicable)
Speed of vessel at time of accident (power vessels only)
Were skiers being towed?
Explain fully how accident occurred
Sketch may be attached
Helmsman/Driver (Person in charge at time of accident)
Relationship to Assured (if applicable)
How long has the licence been held?
Has the licence ever been endorsed or suspended, or the Helmsman/Driver convicted of any Maritime offence?
Please give details.
Details of Loss or Damage (a quotation for repair will be required)
Estimate of Loss
Where can the vessel be inspected?
In your opinion was the accident your Helmsman’s/Driver’s fault?
(b) Have any claims been made on you?
(a) Who was to blame
(b) Did such person admit any liability?
Names of any independent witnesses
Full Name of Witness
Was the incident reported to the Police or Maritime Authorities?
Did you sign a statement?
Has any action been taken or threatened?