Boat Insurance Claim Form

The issue or acceptance of this form is not to be construed as an admission of liability on the part of the Company. Please provide complete details to the questions asked on this form. If there is insufficient space for your answers please use the Additional Information section on the back of this form.

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The issue or acceptance of this form is not to be construed as an admission of liability on the part of the Company.

Please provide complete details to the questions asked on this form. If there is insufficient space for your answers please use the Additional information section of this form.

1. Your Details
Authorised Contact
2. Goods and Services Tax (GST)
What is your entitlement to an input Tax Credit in respect of:
%
%
3. Your Boat Details
4. Type of Claim